Tongue cancer medical therapy: Difference between revisions

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{{Tongue cancer}}
{{Tongue cancer}}
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{{CMG}}; {{AE}} {{Simrat}} {{MAD}}
 
==Overview==
==Overview==
The predominant therapy for tongue cancer is surgical resection. Adjunctive chemotherapy, radiation, chemoradiation, or brachytherapy may be required.
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]], [[Radiation therapy|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.
==Medical Therapy==
 
*Superficial lesions of tongue cancer are treated with single-modality therapy (eg, radiation or surgery)
==Radiation therapy==
*Large lesions are treated with multiple modalities (eg, combined surgery and radiation).
* [[Radiation therapy]] may be used as a treatment for small or [[Superficial (human anatomy)|superficial]] tongue cancers.<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>
*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.
*Because of the [[side effects]] of [[radiotherapy]], younger patients are treated surgically.  
*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.  
*[[Surgery]] or [[radiation therapy]] may be chosen in older patients.  
The therapeutic decision must take into consideration the following factors:
*Large lesions are treated with combined surgery and [[Radiation therapy|radiation]].  
*Patient's age
=====Adjuvant theapy indications<ref name="pmid23184439">{{cite journal| author=Ganly I, Goldstein D, Carlson DL, Patel SG, O'Sullivan B, Lee N et al.| title=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. | journal=Cancer | year= 2013 | volume= 119 | issue= 6 | pages= 1168-76 | pmid=23184439 | doi=10.1002/cncr.27872 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23184439 }}</ref>=====
*Lifestyle
* Patients who have positive resection margins
*Willingness to participate in the therapeutic regimen.
* Patients with bone invasion
===Radiation therapy===
* Patients with positive [[lymph nodes]]
*Radiation therapy may be used as a treatment modality for small or superficial tongue lesions.
* Tumor thickness >4 mm
*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.
* Patients with regional recurrence
*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 given. The majority of patients initially undergo surgical resection; however, many patients have recently been treated with high-dose preoperative radiation therapy with either external radiation therapy plus interstitial radiotherapy with or external beam radiotherapy alone followed by surgical resection of the residual tumor. The latter technique results in a less-extensive tongue resection, without compromising the prognosis.
The three main techniques of radiation therapy administration includes the following:
*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.<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.  
**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.<ref name="pmid2370178">{{cite journal| author=Wendt CD, Peters LJ, Delclos L, Ang KK, Morrison WH, Maor MH et al.| title=Primary radiotherapy in the treatment of stage I and II oral tongue cancers: importance of the proportion of therapy delivered with interstitial therapy. | journal=Int J Radiat Oncol Biol Phys | year= 1990 | volume= 18 | issue= 6 | pages= 1287-92 | pmid=2370178 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2370178 }} </ref>  


===Chemotherapy===
===== Techniques of radiation therapy<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> =====
*Early tumors are not treated with chemotherapy because of the high success of either radiation therapy or surgery.  
*[[External beam radiotherapy]]
*Chemotherapy is used in patients who present with extensive primary lesions, in patients with distant metastasis or with poor prognosis.  
**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.<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>
*The factors to be considered if chemotherapy is being contemplated includes the following:
*[[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 [[Tracheotomy|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 X-rays|Orthovoltage radiotherapy]]
**In patients with well-marginated and exophytic lesions, prior to [[External beam radiotherapy|external beam radiation]] therapy cone therapy is administered. 
**An intraoral cone is placed against the tumor bed and either electrons or [[Orthovoltage X-rays|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.<ref name="pmid2370178">{{cite journal| author=Wendt CD, Peters LJ, Delclos L, Ang KK, Morrison WH, Maor MH et al.| title=Primary radiotherapy in the treatment of stage I and II oral tongue cancers: importance of the proportion of therapy delivered with interstitial therapy. | journal=Int J Radiat Oncol Biol Phys | year= 1990 | volume= 18 | issue= 6 | pages= 1287-92 | pmid=2370178 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2370178  }} </ref>
 
==== '''Non-surgical candidates''' ====
* For patients who are not surgical candidates '''but can tolerate [[chemotherapy]]''', a combined [[chemotherapy]] and [[radiotherapy]] is appropriate.<ref name="pmid12525526">{{cite journal| author=Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F et al.| title=Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial. | journal=J Clin Oncol | year= 2003 | volume= 21 | issue= 2 | pages= 327-33 | pmid=12525526 | doi=10.1200/JCO.2003.06.146 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12525526  }}</ref>
* For patients who are not surgical candidates '''with bad medical condition''' and can not tolerate the [[chemotherapy]], [[Radiation therapy|radiotherapy]] without [[chemotherapy]] is more appropriate.<ref name="pmid19856305">{{cite journal| author=Stenson KM, Kunnavakkam R, Cohen EE, Portugal LD, Blair E, Haraf DJ et al.| title=Chemoradiation for patients with advanced oral cavity cancer. | journal=Laryngoscope | year= 2010 | volume= 120 | issue= 1 | pages= 93-9 | pmid=19856305 | doi=10.1002/lary.20716 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19856305  }}</ref>
* 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.<ref name="pmid2370178" />
*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
**Stage of disease
**General medical status
**General medical status
**Potential efficacy
**Potential efficacy
**Tolerance to adverse effects
**Tolerance to adverse effects
===Chemoradiation===
 
With chemoradiation, chemotherapy is administered at the same time as radiation therapy.  
* There is no evidence to support the use of [[chemotherapy]] for early stage [[oral cavity]] cancer.<ref name="pmid18707827">{{cite journal| author=Gomez DR, Zhung JE, Gomez J, Chan K, Wu AJ, Wolden SL et al.| title=Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers. | journal=Int J Radiat Oncol Biol Phys | year= 2009 | volume= 73 | issue= 4 | pages= 1096-103 | pmid=18707827 | doi=10.1016/j.ijrobp.2008.05.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18707827  }}</ref>
The benefits of chemoradiation includes the following:
 
*Synergism
*Radiosensitization
*Beneficial antiproliferative effects
*Improved llocoregional control
*Improved survival
===Targeted therapy===
===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.
* [[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.<ref name="pmid3220769" />


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 02:17, 3 December 2017

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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

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]

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

Targeted therapy

References

  1. ↑ 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.
  2. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.

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