Tongue cancer medical therapy

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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, or 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 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.

• 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.
• 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.

Chemotherapy

• Early tumors are not treated with chemotherapy because of the high success of either radiation therapy or surgery.
• Chemotherapy is used in patients who present with extensive primary lesions, in patients with distant metastasis or with poor prognosis.
• 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

Chemoradiation

With chemoradiation, chemotherapy is administered at the same time as radiation therapy. The benefits of chemoradiation includes the following:

• Synergism
• Radiosensitization
• Beneficial antiproliferative effects
• Improved llocoregional control
• Improved survival

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.