Tongue cancer medical therapy: Difference between revisions
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{{Tongue cancer}} | {{Tongue cancer}} | ||
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==Overview== | |||
The predominant therapy for tongue cancer is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation/brachytherapy may be required. | |||
==Medical Therapy== | |||
*Superficial lesions of tongue cancer are treated with single-modality therapy (eg, radiation or surgery) | |||
*Large lesions are treated with multiple modalities (eg, combined surgery and radiation). | |||
*Cervical nodes are treated with either surgery or radiation therapy. | |||
*A modality that preserves greatest function but places the patient at a greatest risk of local or regional recurrence should not be used. | |||
*In younger patients tongue cancer is treated surgically to avoid radiation therapy because of the adverse affects of radiation. Premature use of radiation therapy eliminates it from future consideration if the disease recurs. In an older patient, either surgery or radiation therapy may be chosen if the lesion is superficial and small. | |||
The therapeutic decision must take into consideration the following factors: | |||
**Patient's age | |||
**Lifestyle | |||
**Willingness to participate in the therapeutic regimen. | |||
===Radiation therapy=== | |||
*Radiation therapy may be used as a treatment modality for small or superficial tongue lesions. | |||
*For T1 and T2 oral tongue cancers the local control rates are similar for surgery and radiation therapy. However, radiation therapy has the benefit of preserving tongue function and normal anatomy. | |||
*In early or moderately advanced tumors such as T1, T2, early T3, postoperative radiation therapy is considered if adverse histological features are noted in the pathology specimen of the primary tumor or the specimen from elective neck disection. | |||
*In patients who refuse surgery or those who are poor surgical candidates radiation therapy is considered for the primary management of small oral tongue cancers. | |||
*For advanced lesions, combined treatment with surgery is advisable. Most patients initially undergo surgical resection; however, many patients have recently been treated with high-dose (therapeutic) preoperative radiation therapy with either external beam radiotherapy alone or external radiation therapy plus interstitial radiotherapy followed by surgical resection of the residual tumor. The latter technique results in a less-extensive tongue resection, hopefully without compromising the prognosis. | |||
The three main techniques of radiation therapy administration includes the following: | |||
*External beam radiotherapy<ref name="pmid16168836">{{cite journal| author=Bourgier C, Coche-Déquéant B, Fournier C, Castelain B, Prévost B, Lefebvre JL et al.| title=Exclusive low-dose-rate brachytherapy in 279 patients with T2N0 mobile tongue carcinoma. | journal=Int J Radiat Oncol Biol Phys | year= 2005 | volume= 63 | issue= 2 | pages= 434-40 | pmid=16168836 | doi=10.1016/j.ijrobp.2005.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16168836 }} </ref> | |||
*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.<ref name="pmid2807886">{{cite journal| author=McGregor AD, MacDonald DG| title=Patterns of spread of squamous cell carcinoma within the mandible. | journal=Head Neck | year= 1989 | volume= 11 | issue= 5 | pages= 457-61 | pmid=2807886 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2807886 }} </ref><ref name="pmid3220769">{{cite journal| author=McGregor AD, MacDonald DG| title=Routes of entry of squamous cell carcinoma to the mandible. | journal=Head Neck Surg | year= 1988 | volume= 10 | issue= 5 | pages= 294-301 | pmid=3220769 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3220769 }} </ref> | |||
*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. | |||
Chemotherapy | |||
The role of chemotherapy in the management of cancer of the oral tongue is still unclear. Early tumors are not treated with this modality because of the high success of either radiation therapy or surgery. Patients who present with extensive primary lesions or with distant metastases and poor prognoses are good candidates for chemotherapy. Factors to consider if contemplating chemotherapy include stage of disease, general medical status, potential efficacy, and tolerance to adverse effects. | |||
A new strategy for using chemotherapeutic agents is concomitant chemoradiation. With this modality, chemotherapy is administered at the same time as radiation therapy. This approach has multiple benefits, which include synergism, radiosensitization, beneficial antiproliferative effects, possible improved locoregional control, and possible improved survival. | |||
Mayo Clinic radiation oncologists have access to the most advanced radiation therapy treatments, such as intensity-modulated radiation therapy, which precisely targets radiation to tumor cells and limits radiation exposure to nearby normal tissue, and brachytherapy, which places radioactive material close to the tumor site. | |||
Chemotherapy | |||
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be used along with radiation therapy to treat locally advanced tongue cancer. For tongue cancer that has recurred or has spread to other areas of the body, chemotherapy may be recommended to slow the growth of the cancer. | |||
Targeted therapy | |||
Targeted therapy drugs, such as monoclonal antibodies, alter specific aspects of cancer cells that fuel their growth. These drugs can interrupt the spread and growth of specific tongue cancer cells. Targeted therapy is often used in combination with chemotherapy or radiation therapy. | |||
Rehabilitation | |||
Some people need help to improve their swallowing and speech function during and after tongue cancer treatment. At Mayo Clinic, you have access to a variety of experts to help you cope and recover, including specialists in speech and swallowing, physical therapists, occupational therapists, and dietitians. | |||
If cancer or treatment makes it difficult for you to eat enough to get all the nutrients you need, your doctor may recommend tube feeding (enteral nutrition). | |||
The Nicotine Dependence Center at Mayo Clinic can help people who want to stop using tobacco. Continuing to use tobacco increases your risk of a tongue cancer recurrence. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 19:25, 26 November 2015
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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]
Overview
The predominant therapy for tongue cancer is surgical resection. Adjunctive chemotherapy/radiation/chemoradiation/brachytherapy may be required.
Medical Therapy
- Superficial lesions of tongue cancer are treated with single-modality therapy (eg, radiation or surgery)
- Large lesions are treated with multiple modalities (eg, combined surgery and radiation).
- Cervical nodes are treated with either surgery or radiation therapy.
- A modality that preserves greatest function but places the patient at a greatest risk of local or regional recurrence should not be used.
- In younger patients tongue cancer is treated surgically to avoid radiation therapy because of the adverse affects of radiation. Premature use of radiation therapy eliminates it from future consideration if the disease recurs. In an older patient, either surgery or radiation therapy may be chosen if the lesion is superficial and small.
The therapeutic decision must take into consideration the following factors:
- Patient's age
- Lifestyle
- Willingness to participate in the therapeutic regimen.
Radiation therapy
- Radiation therapy may be used as a treatment modality for small or superficial tongue lesions.
- For T1 and T2 oral tongue cancers the local control rates are similar for surgery and radiation therapy. However, radiation therapy has the benefit of preserving tongue function and normal anatomy.
- In early or moderately advanced tumors such as T1, T2, early T3, postoperative radiation therapy is considered if adverse histological features are noted in the pathology specimen of the primary tumor or the specimen from elective neck disection.
- In patients who refuse surgery or those who are poor surgical candidates radiation therapy is considered for the primary management of small oral tongue cancers.
- For advanced lesions, combined treatment with surgery is advisable. Most patients initially undergo surgical resection; however, many patients have recently been treated with high-dose (therapeutic) preoperative radiation therapy with either external beam radiotherapy alone or external radiation therapy plus interstitial radiotherapy followed by surgical resection of the residual tumor. The latter technique results in a less-extensive tongue resection, hopefully without compromising the prognosis.
The three main techniques of radiation therapy administration includes the following:
- External beam radiotherapy[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.[2][3]
- 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.
Chemotherapy The role of chemotherapy in the management of cancer of the oral tongue is still unclear. Early tumors are not treated with this modality because of the high success of either radiation therapy or surgery. Patients who present with extensive primary lesions or with distant metastases and poor prognoses are good candidates for chemotherapy. Factors to consider if contemplating chemotherapy include stage of disease, general medical status, potential efficacy, and tolerance to adverse effects.
A new strategy for using chemotherapeutic agents is concomitant chemoradiation. With this modality, chemotherapy is administered at the same time as radiation therapy. This approach has multiple benefits, which include synergism, radiosensitization, beneficial antiproliferative effects, possible improved locoregional control, and possible improved survival. Mayo Clinic radiation oncologists have access to the most advanced radiation therapy treatments, such as intensity-modulated radiation therapy, which precisely targets radiation to tumor cells and limits radiation exposure to nearby normal tissue, and brachytherapy, which places radioactive material close to the tumor site.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be used along with radiation therapy to treat locally advanced tongue cancer. For tongue cancer that has recurred or has spread to other areas of the body, chemotherapy may be recommended to slow the growth of the cancer.
Targeted therapy
Targeted therapy drugs, such as monoclonal antibodies, alter specific aspects of cancer cells that fuel their growth. These drugs can interrupt the spread and growth of specific tongue cancer cells. Targeted therapy is often used in combination with chemotherapy or radiation therapy.
Rehabilitation
Some people need help to improve their swallowing and speech function during and after tongue cancer treatment. At Mayo Clinic, you have access to a variety of experts to help you cope and recover, including specialists in speech and swallowing, physical therapists, occupational therapists, and dietitians.
If cancer or treatment makes it difficult for you to eat enough to get all the nutrients you need, your doctor may recommend tube feeding (enteral nutrition).
The Nicotine Dependence Center at Mayo Clinic can help people who want to stop using tobacco. Continuing to use tobacco increases your risk of a tongue cancer recurrence.
References
- ↑ 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.
- ↑ McGregor AD, MacDonald DG (1989). "Patterns of spread of squamous cell carcinoma within the mandible". Head Neck. 11 (5): 457–61. PMID 2807886.
- ↑ McGregor AD, MacDonald DG (1988). "Routes of entry of squamous cell carcinoma to the mandible". Head Neck Surg. 10 (5): 294–301. PMID 3220769.