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.
Joseph LJ, Goodman M, Higgins K, et al. Racial disparities in squamous cell carcinoma of the oral tongue among women: a SEER data analysis. Oral Oncol. 2015 Jun. 51 (6):586-92.
Kerawala CJ, Bisase B, Lee J. Panendoscopy and simultaneous primary tumors in patients presenting with early carcinoma of the mobile tongue. Br J Oral Maxillofac Surg. 2008 Dec 30.
Bourgier C, Coche-Dйquйant B, Fournier C, Castelain B, Prйvost B, Lefebvre JL, et al. Exclusive low-dose-rate brachytherapy in 279 patients with T2N0 mobile tongue carcinoma. Int J Radiat Oncol Biol Phys. 2005 Oct 1. 63(2):434-40
Yagi S, Kamei Y, Nakayama B, Toriyama K, Torii S. A new design for free flap reconstruction of the tongue and oropharynx. J Reconstr Microsurg. 2008 Apr. 24(3):211-9.
D. H. Kraus, A. Vastola, A. G. Huvos, R. H. Spiro: Surgical Management of Squamous Cell Carcinoma of the Base of the Tongue. The American journal of surgery, October 1993, vol 166.
Peto R., Pike MC., Design and analysis of randomized from incomplete requiring prolonged observations of each patient. II Analisis and examples, Lancet 1977; 35: 1-39.
Vikram B, Strong EW, Shah JP, Spiro R. Second malignant neoplasms in patients successfully treated with multi-modality treatment for head and neck cancer. Head Neck1984; 1: 734-8.
Weber RS, Gidley P, Morrison WH, et al. treatment selection for carcinoma of the base of the tongue. Am. J. Surg 1990; 160-415-9.
Goffinet D, Fee W, Wells J, et al. 192-iridium pharyngoepiglotic fold of tongue carcinoma by radiation therapy. Cancer 1985; 55: 941-8.
Puthawala A. Syed A. Eads D. et al. Limited external beam and interstitial 192-iridium in the treatment of carcinoma of the base of the tongue: a ten year experience. Int J. radiat Oncol Biol Phys 1987; 14: 839-48
Parsons JT, Million RR, Cassisi NJ. Carcinoma of the base of the tongue: results of radical radiation with surgery reserved for radiation failure. Laryngoscope 1982; 92: 689-96.
Wang CC. Local control of oropharyngeal carcinoma 192after two accelerated hyperfractionation radiation therapy schemes. IntJ. Radiat Oncol Biol Phis 1988; 14: 1143-6.
Pfister DG, Strong EW, Harrison LB, Kraus DH. Larynx preservation treatment in head and neck cancer. In: Forther JG Rhoades JE, editors. Accomplishments in cancer research, 1991 Philadelphia: JB Lippincott, 1992: 240-50.
Pfister DG, Strong EW, Harrison LB, et al, Larynx preservation with combined chemotherapy and radiation therapy in advanced but respectable head and neck cancer. J. Clin Oncol 1991; 9:850-9.
