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"When I was very ill and things looked their worst, nothing was more inspiring to me than reading about how other patients survived against the odds and coped with their situations."
Steve Dunn of CancerGuide.org

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OUTCOME AND PROGNOSIS:
Treatment results for carcinomas of the base of the tongue are measured in terms of speech and swallowing function; the need for gastrostomy or tracheostomy tubes; local, regional, or distant control; and patient survival and quality of life. Historically, patients with advanced-stage disease have been treated with surgical resection and postoperative radiotherapy. Considering all stages, locoregional control rates approach 70-85% versus 50-75% with stage 4 disease following partial glossectomy, neck dissection, and postoperative radiotherapy. Overall survival rates range from 50-65%, with improved survival with early-stage disease. Even in the presence of advanced-stage disease, the mandible and larynx can be preserved in 80% of patients.

Patients with positive surgical margins are at high risk of locoregional failure and death from disease. Among patients with positive or close margins, postoperative radiotherapy doses of 60 Gy or more achieve excellent long-term local control rates. Complications for this approach include pharyngocutaneous fistula and chronic aspiration. Long-term functional outcome data demonstrate decreasing function with increasing T stage following surgical resection. The prevalence rates of regional and distant failure are approximately 20% and 30%, respectively. The actuarial incidence rate of a second primary malignancy of the upper aerodigestive tract is approximately 35% at 5 years.

In an effort to decrease the alteration in speech and swallowing function associated with extensive surgical resection of the base of the tongue, external radiotherapy alone or in combination with brachytherapy and/or neck dissection has been used as a treatment strategy. The best local control rates at 5 years with external radiotherapy alone are, for T1, 96%; for T2, 91%; for T3, 81%; and for T4, 38%. Similarly, brachytherapy alone is effective for lesions smaller than 4 cm, but extensive lesions have reported local recurrence rates of as high as 50-60%. Improved local control rates approaching 80% can be achieved with the combination of external and implant radiation for T1-3 lesions.

The addition of a planned neck dissection for patients with clinically evident regional lymph node metastases offers statistically significant improved regional control (80-90%) and disease-specific survival. A brachytherapy boost (20-30 Gy) to the base of the tongue can be performed at the same anesthesia level used for the neck dissection with temporary tracheostomy.

The addition of chemotherapy to the management of advanced base of tongue carcinoma is ongoing, and the results from this treatment option are not widely reported in the literature. The 5-year disease-specific and absolute survival rates of 50-65% are comparable to surgical resection. The majority of recurrences are evident within the first 2 years following treatment. Complications of radiotherapy include lost of taste/saliva, tissue necrosis, and osteoradionecrosis of the mandible.

Improved quality-of-life data have been reported from selected patients treated with radiotherapy for carcinoma of the tongue base, although no prospective, randomized, or case-matched controlled studies are available in the literature. Advancing T stage is associated with decreased quality-of-life scores regardless of treatment modality. Of all head and neck subsites, treatment of base of tongue cancer has the greatest impact on speech and swallowing function and on quality of life. The addition of neck dissection to primary radiotherapy for tongue base cancer has no impact on posttreatment quality of life.

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Posted 19 September 2007 04:10 PM
I was diagnosed with tongue cancer in January operated in March and Radiotherapy in May 07.

Can you tell me the percetage of re-occurance of tongue cancer please?

It is normal to have anxieties about recurrence. Recurrence Probabilities (Tongue Cancer) were discussed on a thread recently.

Studies have shown that between 10% to 30% of patients with oral cancer subsequently develop second primary tumours of the aerodigestive tract. The longer the patient goes without recurrence, the less likely it is that the cancer will come back. The first two years are the most risky.

One study showed that at two years, the recurrence rate was lower in patients that had combined chemo-radiotherapy treatment as opposed to radiation alone. But the treatment is very hard on the patient. No known medication or supplement has been proven to help prevent or avoid recurrence. However, maintaining a healthy diet and avoidance of such things as cigarettes can decrease the risk of recurrence. See: Spicy Foods and Cancer

You may find BEATING TONGUE CANCER, an interview with a patient and doctor about a recurrence, of interest.

You may also find the Cochrane Systematic Review on Oral Cancer informative and helpful.

Best wishes
Vinod