Cancer of the tongue: A study of the regional lymph node spread

Abstract

The purpose of this study was to collect and report data on different ways of management of the regional neck lymph node metastasis from cancer of the tongue and to evaluate their effectiveness in controlling disease in this region locally. The incidence of lymph node metastasis, its staging, and its relationship with the primary tumor are also discussed briefly. A determinate group of 440 patients with cancer of the tongue treated from 1945–1959 at one institute was studied. A total of 287 patients were found to have regional cervical lymph node metastasis either on first admission or during subsequent follow-up of these patients. The incidence of clinically positive cervical lymph nodes rose from 8.2% in T1 lesions in the primary site to 29.0% in T3 and 58.0% in T4 lesions. Block dissection of the neck was done mostly in patients who developed neck lymph nodes at subsequent follow-up or in patients with N1 disease. This method of management of lymph nodes resulted in local control rate of 20.5 and 24.0% in N0 stage and 28.5 and 26.0% in N1 stage at the end of 5- and 10-year periods, respectively. Radiation only was used mostly in patients who had more advanced disease, i.e., N2 and N3 stages, or in earlier stage if the patient could not be operated on due to a variety of reasons. Results of radiation in this group are poor, but a handful of patients survived with no evidence of disease up to 5 and 10 years. It should be realized, however, that a significant number of these patients receiving irradiation were treated during an era of orthovoltage radiotherapy; most of these patients were poor risks, which might account for poor results of irradiation to regional lymph node metastasis from cancer of the tongue.