Shih-Hsuan Hsiao a, Hon-Yi Lin b, c, Moon-Sing Lee b, c, Dian-Kun Li d, Yu-Chieh Su d, Ching-Chih Lee a, Shih-Kai Hung b, c
aDepartment of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
bDepartment of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
cSchool of Medicine, Tzu Chi University, Hualien, Taiwan
dDepartment of Hematological Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
The aim of this study was to retrospectively analyze advanced oral tongue cancer to determine tumor characteristics, treatment patterns and any other prognostic factors that may influence the survival of patients with the disease.
Patients and Methods
The records of 70 patients with stage III to IVA oral tongue cancer (TNM system) seen between December 1999 and December 2005 at one institution were reviewed. One group of patients had been treated with surgery plus adjuvant therapy (Group A), while the other group of patients had undergone definitive concurrent chemoradiotherapy (CCRT) without surgery (Group B). The chemotherapy protocol consisted of two month ly courses of cisplatin and fluorouracil as a concurrent regimen followed by another 2-month course as an adjuvant systemic regimen. The regimen was cisplatin (20 mg/m2/d) on day 1 and fluorouracil (1000 mg/m2/d) on days 1 to 5.
The 3-year overall survival, disease-free survival, local recurrence and distant metastasis rates in Groups A/B were 76%/18%, 75%/22%, 14%/33% and 13%/27%, respectively. Significant differences were observed in the overall and disease-free survival in the two groups. Multivariate analysis for predictors of overall survival across all patients, treatment types and local recurrence were significant. Furthermore, multivariate analysis to discover predictors of overall survival showed that a positive pathological finding for the margin or a margin < 1 mm in size, and extracapsular spread were significant.
Among the patients who were not candidates for surgery, the effect of definitive CCRT was not satisfactory. A higher dose of radiation was found to result in significantly better survival and local control in Group A. However, in Group B, while local control was better with higher doses, survival did not differ significantly. The effectiveness of radiotherapy might be increased with the use of brachytherapy, the use of more effective drugs such as a radiosensitizer or other recently introduced chemotherapy drugs.
Concurrent chemoradiation; Oral tongue cancer; Prognostic factors; Surgery