Base of Tongue Cancer – Complex Treatment and Results

Abstract

Introduction: The tongue is a muscular organ located in the oral cavity. The tongue is divided into two sections – base, representing the posterior 1/3 and body, occupying the anterior 2/3, ending with a tip. The tongue is flattened vertically so that it has an upper surface, called dorsum, and a ventral surface. The carcinoma may originate from the base of the tongue and involve the valleculae and the linguinal surface of the epiglottis. The primary tumor may grow from the linguinal or laryngeal surface of the epiglottis with infiltration of the valleculae and the base of the tongue. For this reason, it is accepted to use the term „base of tongue – supraglottic complex“ when the location of the primary tumor cannot be determined. Materials and methods: Our study includes 43 patients, diagnosed and treated at the Otorhinolaryngology Clinic of the University Hospital „Sv. Georgi“ EAD – Plovdiv, over a period of 8 years (2009 – 2016) – 39 male and 4 female. The distribution according to stage is as follows: Stage I, 1 patient – 2.3 %; Stage II, 8 patients – 18.6 %; Stage III, 10 patients – 23.2%; Stage IV, 21 patients – 48.8%; recurrences, 3 patients – 6.9%. Twelve patients were diagnosed as inoperable – 27.9%; their tumors were histologically proven and palliative measures were taken, such as tracheostomy, nasopharyngeal airway or gastrostomy tube. In our study, we use extended supraglottic laryngectomy with resection of the base of the tongue for 5 stage IV patients including insertion of a nasopharyngeal airway and tracheostomy. Results: After the multimodal treatment of patients with base of tongue carcinoma involving supraglottic laryngectomy with resection of the base of tongue and postoperative radiation treatment, the following results were achieved. Survival up to 5 years – 2 patients, up to 1 year – 1 patient. Conclusions: • For patients with carcinoma in the „base of tongue – supraglottic complex“, extended supraglottic laryngectomy provides good opportunity to visualize the tumor and enables its radical removal. Our experience indicates that good local control and survival can be achieved using surgical treatment of carefully selected patients. With this operative technique, the functional and cosmetic defects characteristic of the other two surgical approaches are avoided. • The diagnosis of „base of tongue – supraglottic complex“ carcinoma needs to be early in order to achieve better therapeutic results. • Early diagnosis and small tumor volume enable the preservation of a larger part of the base of the tongue following radical excision, which is important for articulation, feeding, and respiration. • The multimodal treatment of patients with „base of tongue – supraglottic complex“ leads to improved results compared to single modality surgery or radiation therapy.