Role of radiotherapy in the treatment of cancer of the tongue.A retrospective analysis on TNM-staged tumors treated between 1958 and 1968

A total of 154 patients with carcinoma of the tongue received a course of radiation therapy between the years 1958 and 1968. Of these, 112 were previously untreated and 42 had tumors which had been treated previously and persisted. Of these, 20 are alive without disease, 22 died of intercurrent disease without recurrence, 11 of second primary tumors, and 101 of cancer. Thirty-four of the 42 patients with recurrence and 67 of 112 previously untreated patients died of cancer. Tumors of limited extent without lymph node metastases were controlled by irradiation in 67% of patients (18 of 27 T1T2N0 lesions). Nine of 27 patients with T1T2N0 lesions and 10 of the 22 patients with T3T4N0 lesions died of cancer of tie tongue. The 5-year survival depended on the extent of the primary tumor varying between 67% for patients with T1N0 to 6 for T4N0 lesions. When the nodes in the neck became clinically involved, the local control rate and the survival rate decreased. However, the majority of patients with an isolated, small, mobile upper cervical node may be cured with radiation therapy (14 of 22 patients with N1 lesions had local control of neck nodes with radiation therapy and only one required radical neck dissection). However, seven of these developed local recurrence in the tongue. Fourteen of the 22 died of cancer. Patients with multiple, bilateral, or fixed cervical nodes have a poor prognosis. We recommend interstitial radiation therapy in early cancers of the tongue, and external high energy beam with supplemental interstitial radiation therapy in the more advanced cases. Weekly examinations of irradiated tumor are carried out to determine if there is any sign of reactivation. If so, radical surgery is performed provided the tumor is operable.