5-year Regional Recurrence Rates Research Articles

The optimal treatment for patients with stage I non-small cell lung cancer: minimally invasive lobectomy versus stereotactic ablative radiotherapy – a nationwide cohort study

ObjectivesThe aim of the Early-Stage LUNG cancer (ESLUNG) study was to compare outcomes after minimally invasive lobectomy (MIL) and stereotactic ablative radiotherapy (SABR) in patients with stage I non-small cell lung cancer (NSCLC). Materials and methodsIn this retrospective cohort study, patients with clinical stage I NSCLC (according to TNM7), treated in 2014–2016 with MIL or SABR, were included. 5-year overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between patients treated with MIL and a propensity score (PS)-weighted SABR population with characteristics comparable to those of the MIL group. Results1211 MIL and 972 SABR patients were included. Nodal upstaging occurred in 13.0 % of operated patients. 30-day mortality was 1.0 % after MIL and 0.2 % after SABR. After SABR, the 5-year regional recurrence rate (18.1 versus 14.2 %; HR 0.74, 95 % CI 0.58–0.94) and distant metastasis rate (26.2 versus 20.2 %; HR 0.72, 95 % CI 0.59–0.88) were significantly higher than after MIL, with similar local recurrence rate (13.1 versus 12.1 %; HR 0.90, 95 % CI 0.68–1.19). Unadjusted 5-year OS and RFS were 70.2 versus 40.3 % and 58.0 versus 25.1 % after MIL and SABR, respectively. PS-weighted, multivariable analyses showed no significant difference in OS (HR 0.89, 95 % CI 0.65–1.20) and better RFS after MIL (HR 0.70, 95 % CI 0.49–0.99). ConclusionOS was not significantly different between stage I NSCLC patients treated with MIL and the PS-weighted population of patients treated with SABR. For operable patients with stage I NSCLC, SABR could therefore be an alternative treatment option with comparable OS outcome. However, RFS was better after MIL due to fewer regional recurrences and distant metastases. Future studies should focus on optimization of patient selection for MIL or SABR to further reduce postoperative mortality and morbidity after MIL and nodal failures after SABR.

De-escalation of axillary treatment in the event of a positive sentinel lymph node biopsy in cT1-2 N0 breast cancer treated with mastectomy: nationwide registry study (BOOG 2013-07).

Trials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1-2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis. Women diagnosed in 2013-2014 with unilateral cT1-2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi-pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others. In total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths. In this registry study of patients with cT1-2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment.

Prognostic value of the 21-gene recurrence score for regional recurrence in patients with estrogen receptor-positive breast cancer.

To evaluate the prognostic value of the 21-gene recurrence score (RS) for regional recurrence (RR) in patients with estrogen receptor-positive breast cancer. We reviewed the medical records of 446 patients who underwent 21-gene RS assay after breast-conserving surgery or mastectomy. The high-RS group was defined as patients who were (1) older than 50years with an RS of 26 or higher, or (2) 50years or younger with an RS of 16 or higher. The 5-year rates of local recurrence (LR), RR, and distant metastasis (DM) were 2.2%, 2.7%, and 4.7%, respectively. The 5-year overall survival (OS) rate was 99.1%. Of the patients, 269 (60.3%) had low-RS, while 177 (39.7%) had high-RS. The 5-year OS rate of the high-RS group was significantly lower than that of the low-RS. The 5-year rates of RR and DM in the high-RS group were significantly higher than those in the low-RS group, while the LR rates did not differ significantly. In multivariable analysis, the high-RS group had a significant relationship with increased RR rate (p = 0.037). Patients who had both high-RS and clinical high-risk features had a significantly higher 5-year RR rate (7.9%) compared with other groups. High-RS was an independent risk factor for RR. The significantly higher RR rate of patients with both high-RS and clinical high-risk features compared with other groups suggests that this patient group can be a potential candidate for regional nodal irradiation.

Oncological Safety of Oncoplastic Level II Mammoplasties After Neoadjuvant Chemotherapy for Large Breast Cancers: A Matched-Cohort Analysis

Oncoplastic surgery (OPS) has extended the indications for breast-conserving surgery (BCS). Its role in patients with large breast cancers treated with neoadjuvant chemotherapy (NAC) is unclear. This study evaluated the oncological safety of OPS for tumors with partial response after NAC. A consecutive series of 65 patients who underwent OPS (study group) after NAC for large breast cancer from January 2004 to July 2018 was compared with 130 matched patients treated by NAC, followed by standard BCS in 65 cases and mastectomy in 65 cases (two case-controlled groups). The mean initial radiological tumor size was 46 mm. Residual pathological tumor size was 22mm in the OPS cohort, 19mm in the standard BCS cohort, and 31mm in the mastectomy cohort (p > 0.05). The mean follow-up was 59 months in the study cohort. Five-year local recurrence rates were 0%, 0%, and 10.5% (0-22%) for the OPS, BCS, and mastectomy cohorts, respectively, while 5-year regional recurrence rates were 4.1% (0-11.1%), 0, and 19.4% (0-35.2%, p > 0.05), respectively. Five-year overall survival was 85.3% for the OPS cohort, 94.1% for the standard BCS cohort (p = 0.194), and 79.9% for the mastectomy cohort (p = 0.165). OPS is safe after NAC for large breast cancers, and provides excellent local control, identical to that of tumors with a better response, treated by standard BCS. After NAC, OPS can be a valuable treatment option for tumors that did not shrink optimally and would not be suitable for standard BCS.

Low Risk of Development of a Regional Recurrence After an Unsuccessful Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence.

Unlike sentinel lymph node biopsy (SLNB) in the primary setting, the repeat SLNB (rSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) is challenging, because it is difficult to visualize and/or harvest a sentinel lymph node in every patient. Regional treatments options and safety in terms of regional disease control after such an unsuccessful rSLNB remain unclear. This study assesses factors associated with the performance of axillary lymph node dissection (ALND) after unsuccessful rSLNB and evaluates the occurrence of regional recurrences. Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 239 patients, the rSLNB was unsuccessful, of whom 60 patients underwent ipsilateral ALND. A shorter time interval between primary treatment and IBTR, and a primary negative SLNB were significantly associated with a higher probability to be treated with ALND after unsuccessful rSLNB (P < 0.001). The 5-year regional-recurrence rate was 0.0% in the ALND group compared with 3.7% in the group treated without ALND (P = 0.113). Of the 179 patients treated without ALND, after a median follow-up of 5.1years (range 0.3-13.2), 7 (3.9%) developed a regional recurrence as first event after unsuccessful rSLNB. None of the seven recurrences occurred in the ipsilateral axilla. Univariable analysis showed no factors associated with regional recurrence as first event after unsuccessful rSLNB (P > 0.05). The present study demonstrates that the risk of regional recurrence in patients with an IBTR and an unsuccessful rSLNB is negligible, irrespective of the use of ALND. This suggests that there is no need for additional treatment of the axilla after an unsuccessful rSLNB.

Regional Recurrence Risk Following a Negative Sentinel Node Procedure Does Not Approximate the False-Negative Rate of the Sentinel Node Procedure in Breast Cancer Patients Not Receiving Radiotherapy or Systemic Treatment.

Although the false-negative rate of the sentinel lymph node biopsy (SLNB) in breast cancer patients is 5-7%, reported regional recurrence (RR) rates after negative SLNB are much lower. Adjuvant treatment modalities probably contribute to this discrepancy. This study assessed the 5-year RR risk after a negative SLNB in the subset of patients who underwent breast amputation without radiotherapy or any adjuvant treatment. All patients operated for primary unilateral invasive breast cancer between 2005 and 2008 were identified in the Netherlands Cancer Registry. Patients with a negative SLNB who underwent breast amputation and who were not treated with axillary lymph node dissection, radiotherapy, or any adjuvant systemic treatment were selected. The cumulative 5-year RR rate was estimated by Kaplan-Meier analysis. A total of 13,452 patients were surgically treated for primary breast cancer and had a negative SLNB, and 2012 patients fulfilled the selection criteria. Thirty-eight RRs occurred during follow-up. Multifocal disease was associated with a higher risk of developing RR (P = 0.04). The median time to RR was 27months and was significantly shorter in patients with estrogen receptor-negative (ER-) breast cancer (9.5months; P = 0.003). The 5-year RR rate was 2.4% in the study population compared with 1.1% in the remainder of 11,440 SLNB-negative patients (P = 0.0002). Excluding the effect of radiotherapy and systemic treatment resulted in a twofold 5-year RR risk in breast cancer patients with a tumor-free SLNB. This 5-year RR rate was still much lower than the reported false-negative rate of the SLNB procedure.

An individualised treatment algorithm for tumour stage 1 glottic squamous cell carcinoma

To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma. A retrospective outcome analysis study was performed using data from a tertiary referral centre. Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent. Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes.

Models predicting non-sentinel node involvement also predict for regional recurrence in breast cancer patients without axillary treatment

Non-SN prediction models are frequently used in clinical decision making to identify patients that may not need axillary treatment, but these models still need to be validated by follow-up data. Our purpose was the validation of non-sentinel node (SN) prediction models in predicting regional recurrences in patients without axillary treatment. We followed a cohort of 486 women with favorable primary tumor characteristics and pN0(i+)(sn) or pN1mi(sn) for median 4.5 years. None of the patients underwent axillary treatment. Based on four published non-SN prediction models, the threshold allowing separation into low versus high-risk on non-SN involvement was set at 10%. Overall 5-year regional recurrence rate was 3.0% (SE, ±0.1%). Using the Tenon scoring system, 438 low-risk patients had a 5-year regional recurrence rate of 2.3% (±0.8%), and 48 high-risk patients a recurrence rate of 10.1% (±0.4%). The MSKCC nomogram identified 300 low-risk patients with a recurrence rate of 2.8% (±1.1%), versus 166 high-risk patients with a rate of 3.4% (±0.5%) (20 patients not assessable). The Stanford nomogram identified 21 high-risk patients without recurrence, and 465 low-risk patients with a 3.2% (±0.9%) recurrence rate. A Dutch model discriminated between 384 low-risk patients with a recurrence rate of 2.2% (±0.8%) and 102 high-risk patients with a rate of 6.3% (±2.9%). The Tenon scoring system outperformed the other models as it identified the largest subgroup of patients with low recurrence rate. In patients resembling our cohort we would recommend axillary treatment if they had a Tenon score above 3.5.

Is the sentinel lymph node pathology protocol in breast cancer patients associated with the risk of regional recurrence?

BackgroundInternationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN) in breast cancer patients. Previously, we reported that ultra-staging led to more axillary lymph node dissections (ALND). The question was, whether ultra-staging is effective in reducing the risk of regional relapse. MethodsFrom January 2002 to July 2003, 541 patients from 4 hospitals were prospectively registered when they underwent a SN biopsy. In hospitals A, B, and C, 3 levels of the SN were examined pathologically, whereas in hospital D at least 7 additional levels were examined. Patients with a positive SN, including isolated tumor cells, underwent an ALND. This analysis focuses on the 341 patients with a negative SN. Primary endpoint was 5-year regional recurrence rate. ResultsIn hospital D 34% of the patients had a negative SN as compared to 71% in hospitals A, B, and C combined (p < 0.001). At 5 years follow-up, 9 (2.6%) patients had developed a regional lymph node relapse. In hospital D none of the patients had a regional recurrence, as compared to 9 (2.9%) cases of recurrence in hospitals A, B, and C. ConclusionThe less intensified SN pathology protocol appeared to be associated with a slightly increased risk of regional recurrence. The absolute risk was still less than 3%, and does not seem to justify the intensified SN pathology protocol of hospital D.

Regional Recurrence in Breast Cancer Patients With Sentinel Node Micrometastases and Isolated Tumor Cells

The impact of axillary treatment in daily practice on 5-year regional recurrence rate in breast cancer patients with isolated tumor cells or micrometastases in the sentinel node (SLN). Axillary dissection is recommended in patients with tumor-positive SLNs. But, in recent studies, regional recurrence rates seemed low if dissection was omitted. We identified all patients in The Netherlands with invasive breast cancer who had an SLN biopsy before 2006, favorable primary tumor characteristics, and node-negative disease, isolated tumor cells or micrometastases as final nodal status. The primary endpoint was regional recurrence rate. To investigate differences in recurrence rates between patients with and without axillary treatment, a proportional hazard regression was carried out correcting for potential confounders. In total, 857 patients with node-negative disease, 795 patients with isolated tumor cells, and 1028 patients with micrometastases in the SLN were included. Without axillary treatment, the 5-year regional recurrence rates were 2.3%, 2.0%, and 5.6%, respectively. Compared with patients who underwent axillary treatment, the adjusted hazard ratio for regional recurrence in patients who underwent an SLN procedure only was 1.08 (95% CI, 0.23-4.98) for node-negative disease, 2.39 (95% CI, 0.67-8.48) for isolated tumor cells, and 4.39 (95% CI, 1.46-13.24) for micrometastases. Doubling of tumor size, grade 3 and negative hormone receptor status were also significantly associated with recurrence. Not performing axillary treatment in patients with SLN micrometastases is associated with an increased 5-year regional recurrence rate. Axillary treatment is recommended in patients with SLN micrometastases and unfavorable tumor characteristics.

PD02-07: Models Predicting Non-Sentinel Node Involvement in Breast Cancer Also Predict for Regional Recurrence If the Axilla Is Not Treated.

Abstract Background Series on breast cancer patients with sentinel node (SN) isolated tumor cells or micrometastases show low recurrence rates in the presence of SN isolated tumor cells, and varying recurrence rates in the presence of SN micrometastases. Non-SN prediction models are frequently used as a decision aid to identify patients that may not need axillary treatment, but this still needs to be validated in respect to regional recurrence. Patients and Methods We followed a cohort of 486 patients in the MIRROR-study of whom none received axillary treatment with favorable primary tumor characteristics and pN0(i+)(sn) or pN1(mi)(sn) for a median of 5 years. The patients were categorized into low or high-risk subgroups based on several published non-SN prediction models (cut-off levels between models varied from 3 to 10%), i.e. the Tenon Scoring system, MSKCC nomogram, Stanford nomogram and a Dutch model (Bolster et al.). The primary endpoint was 5-year regional recurrence-free survival. Results The overall 5-year regional recurrence rate was 3.0% (+/− 0.1%). Using the Tenon scoring system, we identified 438 patients with a low risk score of 3.5 or lower with a 5-year regional recurrence rate of 2.3% (+/− 0.8%), compared to a recurrence rate of 10.1% (+/− 0.4%) in 48 patients with a score above 3.5. For the MSKCC nomogram a low risk score of 0.10 or lower identified 300 patients with a 5-year recurrence rate of 2.8% (+/− 1.1%), and a score above 0.10 identified 166 patients with a recurrence rate of 3.4% (+/− 1.5%) (20 patients not assessable). By the Stanford nomogram a low risk cutoff level of 10% identified 21 patients without recurrence, whereas 465 patients had a 3.2% (+/−0.9%) recurrence rate. Using a Dutch model, a low risk cutoff score of 20 discriminated between 384 patients with a 5-year recurrence rate of 2.2% (+/− 0.8%) and 102 patients with a recurrence rate of 6.3% (+/− 2.9%). Further analyses with different cut-off values and subgroups will be presented at the conference. Conclusion Using several published non-SN prediction models for predicting regional recurrence, the Tenon scoring system outperformed the other models in that it identified the largest subgroup of patients with a low recurrence rate. We would recommend axillary treatment in patients classified as high risk according to the Tenon score. Funding: Netherlands Organization for Health Research and Development (ZonMw 945-06-509). Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD02-07.

Abstract P1-01-31: Axillary Recurrence Rate Is Associated with Sentinel Lymph Node Pathology Protocol

Abstract Background Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN). At present, therefore, various hospitals use different SN pathology protocols, leading to different SN findings and subsequent surgical treatment strategies. Previously, we reported in a prospective registry study of 4 hospitals in the Netherlands, that ultra-staging led to more axillary lymph node dissections (ALND) (Bolster et al. Ann Surg Oncol 2006). This present study reports follow-up data of the patients who had a negative SN, so patients who did not undergo an additional ALND. The question was, whether ultra-staging and thus fewer patients not undergoing an additional ALND, is effective in that it reduces the risk of relapse. Patients and Methods Patients from 4 hospitals (A, B, C, and D) were prospectively registered when they underwent a SN biopsy because of a cytological or histological proven invasive breast cancer. In hospitals A, B, and C, 3 levels of the SN were examined pathologically, whereas in hospital D at least 7 additional levels were examined. In the absence of apparent metastases with H&amp;E examination, immunohistochemical examination was performed in all 4 hospitals. Patients with a positive SN, including isolated tumor cells, underwent an ALND. This analysis focuses on the SN negative patients, who did not undergo a completion ALND. In all cases a follow-up period of at least 5 years was guaranteed. Primary endpoint was 5-year regional recurrence rate. Results Of 541 patients who underwent a SN procedure, 341 (63%) patients had a negative SN, and did not undergo an ALND. In hospital D fewer patients had a negative SN when compared to patients in hospitals A, B, and C (34% versus 71%, P&amp;lt;0.001). At 5 years follow-up, 9 (2.6%) patients showed a regional lymph node relapse. Five (1.5%) patients had an axillary lymph node recurrence and 4 (1.2%) patients a supraclavicular recurrence. In hospital D none of the patients had a regional recurrence, as compared to 9 (2.9%) cases of recurrence in hospitals A, B, and C. Conclusion We showed that patients who underwent a less intensified SN pathology protocol, with a reduced performance of ALND, had a slightly increased risk of recurrence. However, whether this justifies 37 additional lymph node dissections per every 100 patients can be questioned. Therefore, a SN pathology protocol as is used in most centers nowadays, with on average 3 levels per node, seems to be adequate. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-31.

The impact of IMC nodal drainage on primary breast cancer outcome

534 Background: Involvement of the internal mammary node chain (IMC) portends a poor prognosis in primary breast cancer. Theoretically, internal mammary node involvement cannot be present in the absence of primary tumor lymphatic drainage to these nodes. We examined whether the presence of IMC drainage negatively impacted regional and systemic recurrence and overall survival (OS). Methods: We performed a retrospective review of a prospective surgical database of patients with invasive breast cancer (Stage I-III) who underwent preoperative lymphoscintigraphy (LSG) with peritumoral injection and subsequent intraoperative lymphatic mapping from 1996-2002. The study was limited to 1,854 patients who demonstrated drainage on LSG and did not undergo IMC nodal biopsy. Medical records were reviewed for demographics, clinicopathologic data, and medical and surgical treatment data. Outcomes were evaluated including regional and systemic recurrence and overall survival (OS). Patients with any IMC drainage (IM+, alone or with axillary drainage) were compared to those without IMC drainage (IM-) as identified on LSG. Median follow-up was 57.9 months. Results: Three hundred forty-four (18.5%) patients showed IM drainage. Patients with IM drainage were younger and less likely to have upper outer quadrant tumors than those with non-IM drainage (p< 0.0001 for both). Tumor size and axillary sentinel node status were not significantly different between both groups (p=0.08 and p=0.39, respectively). There was no difference in IM irradiation rates of patients who were IM+ versus patients who were IM-. The 5-year systemic recurrence rate was 3.8% for IM+ patients and 2.1% for IM- patients (p=0.07). The 5-year regional recurrence rate was 0.9% for IM+ patients and 0.5% for IM- patients (p=0.46). Only one patient recurred in the IM nodal chain. There was no statistically significant difference in the 5-year OS rates of IM+ versus IM- patients in the entire study cohort as well as in the axillary node positive patients. Conclusions: A finding of IM drainage on LSG was not a significant predictor of OS during this study period. This finding needs to be confirmed at longer follow-up. Further studies are needed to determine the role of the IM sentinel node biopsy. No significant financial relationships to disclose.

Clinical observation of reconstruction with muscle flaps in partial laryngectomy

目的 探讨进一步提高中晚期声门型喉癌患者生存率及生存质量的方法.方法回顾分析53例声门型喉鳞状细胞癌实施喉癌甲状软骨窗式切除带蒂肌瓣修复喉腔术临床资料,其中,T2N036例,T2N13例,T3N012例,T3N12例.临床分期,Ⅱ期36例,Ⅲ期17例.使用电刀结合电锯行喉腔肿瘤、甲状软骨窗式切除术,把制备的肌瓣通过开窗口修复喉腔.单蒂肌瓣修复:胸骨舌骨肌26例,带舌骨、胸骨舌骨肌9例,肩胛舌骨肌5例,双侧肩胛舌骨肌修复喉腔8例.双蒂肌膜肌瓣修复:胸骨舌骨肌4例.Kaplan-Meier计算生存率及肿瘤复发趋势.结果 3、5年生存率分别为91.9%和84.2%,肿瘤复发5例(T2No 3例,T3N01例,T3N01例),肿瘤复发率为11.0%.拔管率为96.2%(51/53),拔管时间为2～4周.发音成功率为100%.结论采用喉癌甲状软骨窗式切除带蒂肌瓣修复喉腔术,基本保留了喉腔的生理形态,修复组织稳定,有利于发音,提高了生存质量。

Treatment results of stage I and II oral tongue cancer with interstitial brachytherapy: Maximum tumor thickness is prognostic of nodal metastasis

Purpose : To evaluate the prognostic importance of T classification and maximum tumor thickness (MTT) on the treatment results of Stage I and II oral tongue cancer treated with interstitial brachytherapy. Methods and Materials : Between January 1981 and December 1993, 173 cases were eligible for this retrospective analysis. Of 173 patients, 75 were classified as Stage I and 98 as Stage II: maximum tumor length ranged from 6 to 40 mm. MTT, which ranged from 2 to 38 mm, was measured with ultraonography and/or palpation. Brachytherapy was performed with iridium hairpins or radium needles following external irradiation in 66 patients, or exclusively in 107 patients. Results : The 5-year local recurrence rates were Stage I, 7%; Stage II, 22%; MTT < 8 mm, 8%; and MTT ≥ 8 mm, 28%. The 5-year regional recurrence rates were Stage I, 15%; Stage II, 29%; MTT < 8 mm, 18%; and MTT ≥ 8 mm, 31%, respectively. The 5-year local recurrence rates of the patients with Stage I and MTT < 8 mm of the brachytherapy only group were significantly better than those of Stage II and MTT ≥ 8 mm (5% and 6% vs. 16% and 24%). The 5-year regional recurrence rates of the patients with Stage I and MTT < 8 mm of the brachytherapy-only group were significantly better than those of Stage II and MTT ≥ 8 mm (14% and 16% vs. 34% and 46%). There was no significant difference in the 5-year regional recurrence rates between the two groups of Stage I and Stage II, MTT < 8 mm. However, there was a significant difference in the 5-year regional recurrence rates between the two groups of MTT ≥ 8 mm ( p < 0.005). Conclusions : For patients with Stage I and II oral tongue cancer, tumor thickness as well as T classification were prognostic for nodal metastasis and prognosis. Patients with MTT ≥ 8 mm are more likely to fail in the neck region. These findings suggest that MTT should be considered along with T stage in determining strategies for Stage I and II oral tongue cancer.