Long term results of primary radiotherapy with/without neck dissection for squamous cell cancer of the base of tongue

Background There are several management options for patients with squamous cell cancer of the base of tongue. We have had an interest in using primary radiotherapy with or without neck dissection, in an effort to provide optimal oncologic as well as functional outcomes. Methods From 1981 to 1995, 68 patients with primary squamous cell cancer of the base of tongue were managed with primary radiotherapy, with neck dissection added for those who were initially seen with palpable lymph node metastases. Ages ranged from 35 to 77 years (median age, 55 years). There were 59 men and 9 women. T Stage distribution was: T1, 17; T2, 32; T3, 17; T4, 2. Fifty-eight patients (85%) were initially seen with nodal metastases. Initial treatment generally involved external-beam radiotherapy (EBRT) to the primary site and upper neck (54 Gy) and to the low neck (50 Gy). A 192-Ir brachytherapy boost (20–30 Gy) to the base of tongue was done about 3 weeks later, at the same anesthesia used for the neck dissection. All patients had temporary tracheostomy. Follow-up ranged from 1 month to 151 months (median, 36 months). Nine patients received neoadjuvant chemotherapy as part of a larynx-preservation protocol. Results Actuarial 5- and 10-year local control is 89% and 89%, distant metastasis free survival is 91% and 76%, diseasefree survival is 80% and 67%, and overall survival is 86% and 52%, respectively. Complications occurred in 16%. Conclusions Our long term data clearly demonstrate that primary radiotherapy produces excellent oncologic outcomes. © 1998 John Wiley & Sons, Inc. Head Neck 20: 668–673, 1998.