Tongue cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohammed Abdelwahed M.D[3]
Overview
The predominant therapy for tongue cancer is surgical resection. It is indicated for patients who have positive resection margins, patients with bone invasion, patients with positive lymph nodes, tumor thickness >4 mm, patients with regional recurrence. For patients who are not surgical candidates but can tolerate chemotherapy, a combined chemotherapy and radiotherapy is appropriate. For patients who are not surgical candidates with bad medical condition and can not tolerate the chemotherapy, radiotherapy without chemotherapy is more appropriate. Chemotherapy is used in patients who present with extensive primary lesions, in patients with distant metastasis or with poor prognosis. Targeted therapy may be used in combination with chemotherapy or radiation therapy. Targeted therapy drugs, such as monoclonal antibodies, interrupt the spread and growth of specific tongue cancer cells.
Radiation therapy
- Radiation therapy may be used as a treatment for small or superficial tongue cancers.[1]
- Because of the side effects of radiotherapy, younger patients are treated surgically.
- Surgery or radiation therapy may be chosen in older patients.
- Large lesions are treated with combined surgery and radiation.
Adjuvant theapy indications[2]
- Patients who have positive resection margins
- Patients with bone invasion
- Patients with positive lymph nodes
- Tumor thickness >4 mm
- Patients with regional recurrence
Techniques of radiation therapy[3]
- External beam radiotherapy
- Depending on tumor size and location, nodal status, and the possible inclusion of interstitial implants, external beam radiotherapy using a single ipsilateral portal or bilateral-opposed portals may be selected.[1]
- Brachytherapy
- Brachytherapy may be used as a single modality or can be used following partial glossectomy. Most often brachytherapy is used after the tumor bed has been preliminarily treated with external beam radiotherapy. It may result in tongue edema, necessitating an elective tracheostomy.[3][4]
- Orthovoltage radiotherapy
- In patients with well-marginated and exophytic lesions, prior to external beam radiation therapy cone therapy is administered.
- An intraoral cone is placed against the tumor bed and either electrons or orthovoltage may be given with equal control rates.
- For tumors less than 2 cm thick, radiotherapy of oral tongue cancer typically combines external beam radiotherapy with an intraoral cone.
- For tumors less than 2 cm thick, radiotherapy combines external beam radiotherapy with an interstitial brachytherapy.
- Small lesions less than or equal to 10 mm and superficial lesions can be treated with either an intraoral cone or interstitial brachytherapy alone.[5]
Non-surgical candidates
- For patients who are not surgical candidates but can tolerate chemotherapy, a combined chemotherapy and radiotherapy is appropriate.[6]
- For patients who are not surgical candidates with bad medical condition and can not tolerate the chemotherapy, radiotherapy without chemotherapy is more appropriate.[7]
- For patients with non-operable tumors and failed medical trials, complete resection may be indicated as a salvage procedure.
- For patients with stage III or IV primary tumors, survival rates do not show improvement.
Chemotherapy
- Chemotherapy is used in patients who present with extensive primary lesions, in patients with distant metastasis or with poor prognosis.[5]
- Early tumors are not treated with chemotherapy because of the high success of either radiation therapy or surgery.
- The factors to be considered if chemotherapy is being contemplated includes the following:
- Stage of disease
- General medical status
- Potential efficacy
- Tolerance to adverse effects
- There is no evidence to support the use of chemotherapy for early stage oral cavity cancer.[8]
Targeted therapy
- Targeted therapy may be used in combination with chemotherapy or radiation therapy.
- Targeted therapy drugs, such as monoclonal antibodies, interrupt the spread and growth of specific tongue cancer cells.[4]
References
- ↑ 1.0 1.1 Bourgier C, Coche-Déquéant B, Fournier C, Castelain B, Prévost B, Lefebvre JL; et al. (2005). "Exclusive low-dose-rate brachytherapy in 279 patients with T2N0 mobile tongue carcinoma". Int J Radiat Oncol Biol Phys. 63 (2): 434–40. doi:10.1016/j.ijrobp.2005.02.014. PMID 16168836.
- ↑ Ganly I, Goldstein D, Carlson DL, Patel SG, O'Sullivan B, Lee N; et al. (2013). "Long-term regional control and survival in patients with "low-risk," early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness". Cancer. 119 (6): 1168–76. doi:10.1002/cncr.27872. PMID 23184439.
- ↑ 3.0 3.1 McGregor AD, MacDonald DG (1989). "Patterns of spread of squamous cell carcinoma within the mandible". Head Neck. 11 (5): 457–61. PMID 2807886.
- ↑ 4.0 4.1 McGregor AD, MacDonald DG (1988). "Routes of entry of squamous cell carcinoma to the mandible". Head Neck Surg. 10 (5): 294–301. PMID 3220769.
- ↑ 5.0 5.1 Wendt CD, Peters LJ, Delclos L, Ang KK, Morrison WH, Maor MH; et al. (1990). "Primary radiotherapy in the treatment of stage I and II oral tongue cancers: importance of the proportion of therapy delivered with interstitial therapy". Int J Radiat Oncol Biol Phys. 18 (6): 1287–92. PMID 2370178.
- ↑ Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F; et al. (2003). "Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial". J Clin Oncol. 21 (2): 327–33. doi:10.1200/JCO.2003.06.146. PMID 12525526.
- ↑ Stenson KM, Kunnavakkam R, Cohen EE, Portugal LD, Blair E, Haraf DJ; et al. (2010). "Chemoradiation for patients with advanced oral cavity cancer". Laryngoscope. 120 (1): 93–9. doi:10.1002/lary.20716. PMID 19856305.
- ↑ Gomez DR, Zhung JE, Gomez J, Chan K, Wu AJ, Wolden SL; et al. (2009). "Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers". Int J Radiat Oncol Biol Phys. 73 (4): 1096–103. doi:10.1016/j.ijrobp.2008.05.024. PMID 18707827.