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Is Radiation Therapy a Preferred Alternative to Surgery for Squamous Cell Carcinoma of the Base of Tongue?

From the Departments of Radiation Oncology and Otolaryngology, University of Florida College of Medicine, Gainesville, FL.

Address reprint requests to William M. Mendenhall, MD, Department of Radiation Oncology, University of Florida Health Science Center, PO Box 100385, Gainesville, FL 32610-0385; email mendewil@ shands.ufl.edu.

PURPOSE: To evaluate irradiation alone for treatment of base-of-tongue cancer.

PATIENTS AND METHODS: Two hundred seventeen patients with squamous cell carcinoma of the base of tongue were treated with radiation alone and had follow-up for 2 years.

RESULTS: Local control rates at 5 years were as follows: T1, 96%; T2, 91%; T3, 81%; and T4, 38%. Multivariate analysis revealed that T stage (P = .0001) and overall treatment time (P = .0006) significantly influenced local control. The 5-year rates of local-regional control were as follows: I, 100%; II, 100%; III, 83%; IVA, 64%; and IVB, 65%. Multivariate analysis revealed that the following parameters significantly affect the probability of this end point: T stage (P = .0001), overall treatment time (P = .0001), overall stage (P = .0131), and addition of a neck dissection (P = .0021). The rates of absolute and cause-specific survival at 5 years were as follows: I, 50% and 100%; II, 81% and 100%; III, 65% and 76%; IVA, 42% and 56%; and IVB, 44% and 52%. Severe radiation complications developed in eight patients (4%).

CONCLUSION: The likelihood of cure after external-beam irradiation was related to stage, overall treatment time, and addition of a planned neck dissection. The local-regional control rates and survival rates after radiation therapy were comparable to those after surgery, and the morbidity associated with irradiation was less.

Presented at the Forty-first Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Antonio, TX, October 31–November 4, 1999.

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