(P027) Salvage of ‘Low-Risk’ Oral Tongue Failures Initially Managed With Surgery Alone-Importance of Recurrent Stage

April 15, 2014

Adjuvant therapy is not recommended after resection of oral tongue cancer in the absence of risk factors for recurrence. Having reported a 73% locoregional control rate for patients managed with surgery alone for ‘low-risk’ oral tongue cancer, this series examines our experience treating locoregional failures.

Thomas Galloway, MD, Dennis Sopka, MD, Tianyu Li, MS, Ranee Mehra, MD, Jeffrey Liu, MD, Miriam Lango, MD, Barbara Burtness, MD, John A. Ridge, MD, PhD; Fox Chase Cancer Center

Introduction: Adjuvant therapy is not recommended after resection of oral tongue cancer in the absence of risk factors for recurrence. Having reported a 73% locoregional control rate for patients managed with surgery alone for ‘low-risk’ oral tongue cancer, this series examines our experience treating locoregional failures.

Methods: Between 1990 and 2010, 126 patients at our institution were treated with primary surgery (+/− neck dissection) for stage I–II oral tongue cancer. Resection of locoregional recurrence was undertaken if clinically and technically indicated, followed by risk-adapted adjuvant therapy. Median follow-up after completion of salvage therapy was 3.0 years (range: 0.0–17.9 yr), including two patients who died during salvage radiation. Potential prognostic variables were analyzed. Kaplan-Meier curves were constructed to analyze outcomes.

Results: A total of 28 patients developed locoregional recurrence; median time to locoregional failure was 1.1 years (range: 0.4–4.5 yr), and 75% of failures occurred in the first 2 years. Failures were more common at the primary site (n = 19, 68%) than the neck (n = 9, 32%).

The majority (n = 21, 75%) was initially treated with an operation; the remaining patients were treated with definitive (chemo)radiation (n = 4) or declined further therapy (n = 3). Adjuvant radiation was delivered to 11 (51%) patients (2 with concurrent systemic therapy).

Locoregional control at 3 years was 81%, disease-free survival (DFS) was 70%, and overall survival (OS) was 54%. The strongest determinants of worse DFS were increasing recurrent T-stage (P = .008), neck recurrence (P = .06), and extracapsular spread in recurrent neck nodes (P = .008). Early-stage recurrences (recurrent stage T1–2 N0) did well (DFS, 100% at 3 years). The prognosis of neck failures was poor (DFS, 45% at 3 years).

Conclusions: Recurrence of low-risk oral tongue cancer can be successfully salvaged in the majority of cases. Neck failures have a worse prognosis than local failures.