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Experience of the curie institute in treatment of cancer of the mobile tongue 2. management of the neck nodes






Cancer 47(3): 503-508

Experience of the curie institute in treatment of cancer of the mobile tongue 2. management of the neck nodes

Treatment of neck nodes of 602 patients with cancer of the mobile tongue was mainly surgical. A total of 388 patients (64%) were clinically [stage] N0; 244 had elective neck dissection. Thirty-four percent (84/244) had occult metastasis. Thirteen percent (33/244) had major nodal involvement (> 3N+ and/or extracapsular spread) and received postoperative radiotherapy. Twenty-one percent (7/33) recurred in the neck. Thirty-six percent (12/33) were alive, NED [no evidence of disease], at 5 yr. Sixty-six percent (160/244) were N; 21% (51/244) had minimal nodal disease (.ltoreq. 3N +) and did not receive postoperative radiotherapy; recurrence in neck (7% and 14%) and the 5 yr survival (54% and 51%) were similar. Twenty-one patients had preoperative radiotherapy to the neck. Only 1 (5%) experienced recurrence of disease. Fifty had radiotherapy only. Seven (14%) failed in the neck. There were 219 patients who had clinically positive nodes; 120 had radical neck dissection. Of these patients, 101 did not receive preoperative radiotherapy. Sixty-three percent (64/101) had nodal metastasis; 27% (27/101) had major nodal involvement. In this group of patients, for the same degree of nodal involvement, postoperative recurrence in neck and the survival were similar to that of patients with clinically N0 neck, except for those with major nodal involvement. This latter group had a dismal 5-yr survival (12%). Nineteen had preoperative radiotherapy; 3 (16%) had recurrence of disease in the neck. At present, patients with clinically N0 neck and small primary (.ltoreq. 3 cm) tumors, who are at low risk of failure at primary, receive brachytherapy and conservative neck dissection. Postoperative radiotherapy is given if major nodal metastasis exists. Those with larger primary tumors (high risk of failure) receive neck irradiation only, since many will require combined resection at a later date. All patients with clinically positive nodes are treated preoperatively with 5500 rad before neck dissection.

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Accession: 005419973

PMID: 7226002



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