Treatment Options for Tongue Carcinoma
For patients diagnosed with carcinoma of the tongue, treatment should be determined based on tumor stage, location, and patient factors, with surgery being the preferred primary treatment for oral tongue cancers and chemoradiotherapy often recommended for advanced or base of tongue tumors. 1
Initial Assessment and Staging
Before determining treatment, comprehensive evaluation is essential:
- Mandatory biopsy for pathological confirmation
- Complete head and neck examination
- Contrast-enhanced CT and/or MRI for assessment of primary tumor and neck
- Chest imaging to rule out metastases or second primaries
- PET-CT recommended for stage III-IV disease 1
- Dental/prosthodontic evaluation with jaw imaging 1
Treatment Options by Location and Stage
Oral Tongue Carcinoma
Early Stage (T1-T2):
- Surgery is the preferred primary treatment option 1
- Conservative approaches including transoral techniques
- Partial glossectomy with appropriate margins
- Selective neck dissection may be indicated even for clinically negative neck
Advanced Stage (T3-T4):
Base of Tongue Carcinoma
Early Stage:
- Either surgery or primary radiotherapy
- Higher likelihood of regional metastasis compared to oral tongue tumors 2
Advanced Stage:
- Concurrent chemoradiotherapy is often preferred for organ preservation 3, 1
- High-dose cisplatin (100 mg/m² on days 1,22, and 43) is preferred when using systemic therapy/RT 3
- Total laryngectomy may be indicated for extensive disease with laryngeal involvement 3
- Induction chemotherapy with management based on response is an option 3
Surgical Considerations
- Comprehensive neck dissection for the side with clinically positive nodes (levels I-V) 1
- Selective neck dissection (levels I-IV) for the contralateral side when indicated 1
- Bilateral neck dissection is mandatory for tumors crossing the midline 1
- For extensive tumors with poor pretreatment function, more extensive surgery rather than organ-preservation approaches may achieve better outcomes 1
Radiation and Systemic Therapy Options
- Intensity-modulated radiation therapy (IMRT) is preferred to minimize xerostomia 1
- For patients requiring systemic therapy:
Prognostic Factors and Survival
- TNM stage is the most important prognostic factor 4
- 5-year survival rates vary significantly by location and stage:
- Patients with base of tongue tumors typically present with more advanced disease and poorly differentiated lesions, resulting in poorer prognosis 2
Post-Treatment Follow-up
- Regular clinical examinations to monitor for recurrence and second primaries
- Most recurrences occur within the first 2 years after treatment 1
- Imaging studies as clinically indicated
- Assessment of treatment-related complications and functional outcomes
- Thyroid function monitoring with TSH every 6-12 months after neck irradiation 1
- Nutritional assessment and support as needed 1
Important Clinical Considerations
- Base of tongue tumors often present with advanced disease due to fewer early symptoms compared to oral tongue tumors 2
- Accurate imaging assessment of depth of invasion is crucial for staging, with intraoral ultrasonography being most accurate for early-stage tumors 5
- Patient factors such as age, alcohol consumption, and p53 expression may influence prognosis within specific stages 4