Objective: To audit our management policy of treatment of clinically N0 (cN0) early-stage squamous cell carcinoma of the oral tongue (SCCOT). Design: Retrospective review of patients treated between 1986 and 1996. Setting: Tertiary cancer center. Patients: A total of 215 patients with previously untreated T1 (n=110) or T2 (n=105) cN0 SCCOT were identified. The median age was 59 years (age range, 14-88 years). Elective neck dissection (END) was performed in 51%, while the neck was observed in 49%. The END and surveillance groups differed significantly for the following features: clinical stage T2 (72% vs 28%), depth of invasion greater than 2 mm (68% vs 32%), poorly differentiated grade (75% vs 25%), and postoperative radiation therapy (33% vs 1%). Main Outcome Measures: 5-year overall survival (OS), disease-specific survival (DSS), and neck recurrence rate (NRR). Results: With a median follow-up of 93 months (range, 1-236 months), 5-year OS and NRR for the END vs surveillance groups were 73% vs 83% and 23% vs 20% (P>.05). The DSS for the END group was 78% vs 92% for the surveillance group (P = .009). Tumor size greater than 2 cm, depth of invasion greater than 2 mm, and high histologic grade were significant predictors of pathologically positive nodes in the END group. Conclusion: Our policy of selective observation in patients with cN0 T1-T2 SCCOT is effective. Selected patients with tumors less than 2 cm in size, less than 2 mm in depth, and well-differentiated grade are suitable for observation of the cN0 neck.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Aug 1, 2006
Keywords: upper thoracic spine