Treatment of Tongue Carcinoma

Surgery is the preferred treatment for tongue carcinoma, with specific approaches determined by tumor stage, location, and patient factors. 1

Initial Assessment and Staging

Complete clinical examination to document tumor characteristics and assess for infiltration of adjacent structures 1
Biopsy is required for histological confirmation 1
Evaluation of cervical lymph nodes is essential, as regional node involvement at presentation is evident in approximately 30% of patients 1
Standard imaging includes chest X-ray and orthopantomography 1
CT with contrast and/or MRI with contrast of primary and neck as indicated 1
Consider PET-CT for stage III-IV disease 1
Dental/prosthodontic evaluation, including jaw imaging as indicated 1

Surgical excision is preferred for T1-T2 oral cavity tumors 1, 2
Options include:
- Excision of primary with ipsilateral or bilateral neck dissection (guided by tumor thickness) 1
- For anterior tongue cancers, consider bilateral neck dissection due to high rate (50-60%) of occult neck metastases 1
Radiotherapy alone is an alternative for patients who are medically inoperable or refuse surgery 1, 3
Single-modality treatment is recommended to avoid compromising functional outcomes 1
Surgical treatment for T1-T2 tumors has shown 5-year survival rates of up to 96.1% compared to 45.5% with primary radiotherapy 4

Surgery followed by adjuvant therapy is recommended 1, 2
For resectable tumors, surgical approach includes:
- Excision of primary tumor with appropriate margins 1
- Neck dissection (ipsilateral or bilateral depending on tumor location) 1
Postoperative chemoradiotherapy (preferred, category 1) is recommended for patients with adverse pathologic features 1:
- Extracapsular nodal spread
- Positive mucosal margins
For other risk features (pT3/pT4 primary, N2/N3 nodal disease, nodal disease in levels IV/V, perineural invasion, vascular tumor embolism), consider postoperative radiotherapy with or without chemotherapy 1

For T1-T3 base of tongue disease, surgery with or without radiotherapy provides similar local control rates (70-90%) 1, 2
For T4 base of tongue tumors, combination of surgery and radiotherapy may offer an advantage 1, 2, 5
Local control rates for advanced primary tumors: 55% with definitive radiotherapy vs 79% with surgery and postoperative radiotherapy 6
Tumor growth patterns influence treatment response - exophytic tumors respond better to radiotherapy (84% control) than ulcerative-infiltrative tumors (58% control) 6

Postoperative chemoradiotherapy (preferred, category 1) for extracapsular nodal spread and/or positive mucosal margins 1
Concurrent single agent cisplatin at 100 mg/m² every 3 weeks is recommended 1
For other risk features (pT3/pT4 primary, N2/N3 nodal disease, nodal disease in levels IV/V, perineural invasion, vascular tumor embolism), consider postoperative radiotherapy with or without chemotherapy 1
Delaying adjuvant therapy beyond 6 weeks post-surgery can negatively impact outcomes 2

Multidisciplinary team involvement is particularly important for oral cavity tumors due to critical physiologic functions of mastication, deglutition, and speech articulation 1
Nutrition, speech, and swallowing evaluation/therapy as indicated 1
Advances in reconstruction using microvascular techniques have improved functional outcomes after primary surgical management 1

Delaying the start of adjuvant therapy beyond 6 weeks after surgery 2
Combining surgery with radiotherapy for early-stage disease, as functional outcomes may be compromised by combined-modality therapy 1
Underestimating the risk of occult neck metastases, particularly in anterior tongue cancers (50-60%) 1
Inadequate surgical margins, as patients with clear resection margins have better disease-specific survival 5