Node Out, About It? Consideration of Adjuvant Treatment of Oral Tongue Cancer

Abstract

A 32-year-old female nonsmoker with no known family history of cancer presented to her primary care physician after a nonhealing wound in her tongue for 5 months that did not respond to conservative measures. A computed tomography scan of the neck revealed a 0.8 cm enhancing mass within the right mid to posterior tongue. There was no palpable lymphadenopathy or enlarged nodes on imaging. The patient underwent a right partial glossectomy and right neck dissection of levels 2 through 4. Pathology revealed a 1.5 cm × 0.7 cm (DOI) keratinizing squamous cell carcinoma with areas of moderate dysplasia. The closest margin was 0.8 cm. No lymphovascular invasion or perineural invasion was seen histologically. Right neck dissection revealed one 1.1 cm right level 2 node out of a total of 22 nodes without extranodal extension. 1.Would you recommend postoperative radiation therapy?2.If you recommended radiation therapy, would you treat the primary? Unilateral neck or bilateral neck?3.Would you consider adding systemic therapy for this patient or enrollment on a clinical trial such as Radiation Therapy Oncology Group 0920? Your First Shot Is Your Best ShotInternational Journal of Radiation Oncology, Biology, PhysicsVol. 112Issue 4PreviewThe case presented is of a T2N1M0 stage III oral tongue squamous cell cancer in a young, nonsmoking woman.1 This designation (young, nonsmoking woman with tongue cancer) immediately brings to mind those patients we have all had who had terribly aggressive disease courses despite ostensibly low- to moderate-risk pathology. In addition to this initial instinct to treat this patient with adjuvant radiation, T2N1 oral cavity cancer is typically more aggressive than T2N1 oropharynx or larynx cancer. A 7-mm-deep lesion that has already spread to the neck despite the lack of other adverse pathologic features (poor differentiation, lymphovascular invasion, perineural invasion) demonstrates the ability to behave more aggressively than one would expect and therefore warrants adjuvant therapy. Full-Text PDF Depth of Invasion in Oral Tongue Cancer and Risk of Regional FailureInternational Journal of Radiation Oncology, Biology, PhysicsVol. 112Issue 4PreviewTreatment of a young, nonsmoking female patient with oral tongue cancer represents a well-recognized clinical challenge.1 In this case, the patient presented clinically as T1N0M0. However, after partial glossectomy and elective neck dissection, pathology revealed a pT2N1 lesion that was upstaged based on a depth of invasion of 7 mm . Full-Text PDF