Contralateral Neck Recurrence Following Unilateral Treatment for Oral Tongue Squamous Cell Carcinoma
Purpose/Objective
Carcinoma of the oral cavity is rare, however oral tongue carcinoma has been associated with worse prognosis when compared to other oral cavity subsites.
A retrospective study of oral cavity cancer treated with both surgery and radiotherapy, demonstrated a contralateral relapse rate of 25% in patients with ipsilateral pN2b disease.
Irradiation of the contralateral neck in oral tongue carcinoma has been a topic of controversy and debate. We set out to analyse our experience of contralateral neck recurrence in oral tongue squamous cell carcinoma (SCC).
Material/Methods
Electronic patient records were reviewed of patients diagnosed from 2010-2020 with oral tongue SCC. All patients underwent surgery to primary and or neck followed by adjuvant radiotherapy with or without chemotherapy. Patient demographics, tumour characteristics, treatment details and outcomes were collated.
Results
A total 86 patients were identified during this period who underwent unilateral treatment. Median age 61 years; 55 Male, All patients had lateral oral tongue tumours; 44 on the right side. Surgery included wide local excision (WLE) and primary closure without treatment for neck (26 patients); or WLE, flap reconstruction and modified or selective neck dissection (Levels 1 to 4) in 60 patients. Majority were early stage (I & II) in 59 patients; Stage III in 4 and Stage IVa in 23 patients. 23 patients received post-operative radiotherapy, of which 8 patients received concurrent chemotherapy. Median follow up of 7.1 years.
Recurrence was seen in 18 patients (21%). Four patients developed local recurrence alone, 6 patients developed local and nodal recurrence, nodal recurrence alone in 6 patients and distant metastases in 3 patients. The contra lateral nodal recurrence occurred in 7 (8.1%) patients. Of these, three patients had local recurrence along with neck recurrence and 2 patients had neck and distant metastases. Median time to recurrence was 9 months. Five of the 7 patients had Stage IVa disease.
Conclusion
Our contralateral neck recurrence rate following unilateral treatment for oral tongue cancer is 8.1%. Two patients developed contra lateral neck recurrence alone and underwent salvage neck dissection.
In our experience, unilateral treatment for early lateralised oral tongue tumours results in good loco regional control.
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