versão On-line ISSN 2078-5151
versão impressa ISSN 0038-2361
S. Afr. j. surg. vol.46 no.1 Cape Town Fev. 2008
HEAD AND NECK SURGERY
Anton C. van LieropI; Ola Basson, B.ScII; Johannes J. FaganIII
IM.B. CH.B., F.C.O.R.L. (S.A.), M.MED. (ORL.) Division of Otolaryngology, University of Cape Town
II(MED.), M.B. CH.B., F.C.S. (S.A.) ORL. Division of Otolaryngology, University of Cape Town
IIIM.B. CH.B., F.C.S. (S.A.), M.MED. (OTOL.) Division of Otolaryngology, University of Cape Town
Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However, even though total glossectomy is a major surgical procedure that impacts on speech, deglutition and quality of life, it may offer patients the best chance of cure in many centres, especially in the developing world.
METHODS: We did a retrospective chart review of all patients at Groote Schuur Hospital, Cape Town, who had undergone total glossectomy, with or without total laryngectomy, for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004.
RESULTS: Eight patients had a total glossectomy performed during the study period. At 2, 3 and 5 years 63%, 38% and 25% of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding, and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88%) reported pain relief following surgical excision. Perineural invasion was present in 75%, and 38% had positive resection margins. Five patients had recurrence, 2 cervical, 1 local, and 2 local and cervical.
CONCLUSION: Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option, particularly in the developing world setting. It has cure rates superior to primary radiotherapy, and provides motivated patients with excellent pain relief and a reasonable quality of life.
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1. Watkinson JC, Gaze MN, Wilson JA, eds. Tumours of the oropharynx. In: Stell and Maran's Head and Neck Surgery. 4th ed. Oxford: Butterworth Heinemann, 2000: 319-334. [ Links ]
2. Mashberg A, Boffette P, Winkelman R, et al. Tobacco smoking, alcohol drinking, and cancer of the oral cavity and oropharynx among US veterans. Cancer 1993; 72: 1369-1375. [ Links ]
3. Seikaly H, Rassekh CH. Oropharyngeal cancer. In: Bailey BJ, ed. Head Neck Surgery - Otolaryngology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2001: 1427-1441. [ Links ]
4. Harrison D. The questionable value of total glossectomy. Head Neck Surg 1983; 6: 632-638. [ Links ]
5. Barry B, Baujat B, Albert S, Nallet E. Total glossectomy without laryngectomy as first-line or salvage therapy. Laryngoscope 2003; 113: 373-376. [ Links ]
6. Rodriguez R, Perry C, Soo KC, Shaw HJ. Total glossectomy. Am J Surg 1987; 154: 415-418. [ Links ]
7. Bova R, Cheung I, Coman W. Total glossectomy: is it justified? Aust NZ J Surg 2004; 74: 134-138. [ Links ]
8. Ruhl CM, Gleich LL, Gluckman JL. Survival, function, and quality of life after total glossectomy. Laryngoscope 1997; 107: 1316-1321. [ Links ]
9. Gehanno P, Guedon C, Beatrice B, Depondt J. Advanced carcinoma of the tongue: total glossectomy without total laryngectomy. Review of 80 cases. Laryngoscope 1992; 102: 1369-1371. [ Links ]
10. Donaldson RC, Skelly M, Paletta FX. Total glossectomy for cancer. Am J Surg 1968; 116: 585-590. [ Links ]
11. Weber RS, Ohlms L, Bowman J, Jacobs R. Functional results after total or near total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg 1991; 117: 512-515. [ Links ]
12. Tiwari R, Karim AB, Greven AJ, Snow GB. Total glossectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg 1993; 119: 945-949. [ Links ]
13. Davidson J, Brown D, Gullane P. A re-evaluation of total glossectomy. J Otolaryngol 1993; 22: 160-163. [ Links ]
14. Van de Pol M, Levendag PC, de Bree RR, Franssen JH, Smeele LE. Radical radiotherapy compared with surgery for advanced squamous cell carcinoma of the base of tongue. Brachytherapy 2004; 3: 78-86. [ Links ]
15. Robertson ML, Gleich LL, Barrett JL, Gluckman JL. Base-of-tongue cancer: survival, function, and quality of life after external-beam irradiation and brachytherapy. Laryngoscope 2001; 111: 1362-1365. [ Links ]
16. Barrett WL, Gluckman JL, Wilson KM, et al. A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation. Brachytherapy 2004; 3: 240-245. [ Links ]
17. Cano ER, Johnson JT, Carrau R, Agarwala S, Flickinger J. Brachytherapy in the treatment of stage IV carcinoma of the base of tongue. Brachytherapy 2004; 3: 41-48. [ Links ]
18. Shedd DP, Scatliff JA, Kirchner JA. A cineradiographic study of postresectional alterations in oropharyngeal physiology. Surg Gynecol Obstet 1960; 110: 69-89. [ Links ]