From the Guidelines
Tongue cancer treatment should be discussed in a multidisciplinary team (MDT) and patients should be treated at high-volume facilities to optimize outcomes. The treatment strategy for tongue cancer, a type of squamous cell carcinoma of the oral cavity, should be based on patient- and treatment-related factors, such as side effects and complications, as conservative surgery and radiation therapy (RT) may often provide similar locoregional control 1.
Treatment Options
- Early disease should be treated as much as possible with a single-modality treatment, such as surgery or RT alone 1.
- For locally advanced disease, standard options include surgery plus adjuvant (chemo)radiation therapy (CRT) or primary concomitant CRT 1.
- Primary surgical treatment followed by RT or CRT is the preferred treatment for T3/T4 oral cavity cancers 1.
- Concomitant CRT increases locoregional control and overall survival (OS) compared with RT alone, and a hypoxic radiosensitiser can also increase locoregional control and disease-free survival compared with RT alone 1.
Chemotherapy
- The standard of care for chemotherapy (ChT) is cisplatin at a dose of 100 mg/m² given on days 1,22, and 43 of concomitant RT (70 Gy) 1.
- In patients unfit for cisplatin, carboplatin combined with 5-FU or cetuximab concomitant to RT, as well as hyperfractionated or accelerated RT without ChT, are treatment alternatives 1.
- Pembrolizumab in combination with platinum/5-FU and pembrolizumab monotherapy are approved regimens for patients with recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN) expressing PD-L1 (CPS 1) 1.
Postoperative Care
- Postoperative RT is recommended for patients with pT3/T4 tumors, resection margins with macroscopic (R2) or microscopic (R1) residual disease, perineural infiltration, lymphatic infiltration, >1 invaded lymph node, and the presence of extracapsular infiltration 1.
- Postoperative CRT is recommended for patients with an R1 resection and extracapsular rupture 1.
- Postoperative RT or CRT should start within 6-7 weeks of surgery 1.
From the Research
Treatment Options for Tongue Cancer
- There are various treatment options for tongue cancer, including surgery, radiation therapy, and chemotherapy 2, 3, 4, 5, 6.
- The choice of treatment depends on the stage and location of the cancer, as well as the patient's overall health.
Chemotherapy and Radiation Therapy
- Chemotherapy and radiation therapy can be used together to treat tongue cancer, with studies showing promising results 2, 3, 4, 5.
- One study found that concurrent platinum-based chemotherapy and simultaneous modulated accelerated radiation therapy resulted in excellent survival rates and organ function for patients with base of tongue cancer 4.
- Another study found that arterial chemoradiotherapy using cisplatin with sodium thiosulfate resulted in excellent therapeutic results for locally advanced tongue cancer 5.
Surgery and Induction Chemotherapy
- Surgery can be used to treat tongue cancer, either alone or in combination with induction chemotherapy and risk-adapted adjuvant therapy 6.
- One study found that tongue conservation treatment with induction chemotherapy, surgery, and risk-adapted adjuvant therapy was feasible for patients with oral tongue squamous cell carcinoma who were good responders to induction chemotherapy 6.
Patient Outcomes
- Patient outcomes for tongue cancer treatment vary depending on the stage and location of the cancer, as well as the treatment used.
- Studies have shown that patients with base of tongue cancer who receive concurrent radiation therapy and targeted cisplatin chemotherapy (RADPLAT) have excellent survival rates and organ function 2.
- Another study found that patients with stage III and IV base of tongue cancer who received paclitaxel, ifosfamide, and cisplatinum induction chemotherapy followed by chemoradiotherapy had a high complete response rate and excellent survival rates 3.