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Oncología (Barcelona)

Print version ISSN 0378-4835


CORDOBA, S. et al. Observación frente al tratamiento electivo en cáncer de lengua móvil con cuello clínicamente negativo: resultados de una serie de 243 pacientes. Oncología (Barc.) [online]. 2004, vol.27, n.1, pp.25-32. ISSN 0378-4835.

PURPOSE: To determine the role of the neck elective treatment and the risk of occult lymph node metastases in clinically negative (N0) early stage mobile tongue carcinomas. METHODS AND MATERIALS: The study of 243 out of 318 patients with histologically confirmed mobile tongue carcinomas with clinically negative neck seen between 1967 and 1999 is presented. The sample consisted of 187 males and 56 females with a median age of 57 years (range, 24-89 years). According to the 2002 TNM stage classification, 69 patients belonged to stage I, 101 patients to stage II, 39 patients to stage III, and 11 patients to stage IV. The primary tumors were treated by brachytherapy alone (121 patients), external beam radiation therapy alone (17 patients) or a combination of both (105 patients). The management of the neck lymph nodes was individualized according to the characteristics of the patients: 13 were treated with elective neck dissection, 17 with elective neck irradiation (median dose 50 Gy), and 103 patients were carefully followed up without any elective treatment. The statistical analysis was made by means of the Kaplan-Meyer and Log-rank tests for survival curves comparison. RESULTS: The five-year actuarial cause-specific survival and the local control were 65.3 and 66.9%, respectively. The general five-year loco-regional disease-free survival was 52%. The nodal relapse rate according to the treatment modality employed was 0% for elective neck dissection, 21.3% for elective radiation therapy, and 25.7% for the cases followed up without any elective treatment. The corresponding regional disease-free survivals were 100%, 78.7% and 74.3% (p = NS). The prognostic variables offered by the subset of patients without any elective therapy were analyzed to evaluate the risk of occult node metastases. Tumor thickness was identified as a prognostic factor of regional relapse by multivariate analysis; the 5-year regional disease-free survival was 86.7% for a thickness <1 cm vs 16.8% for a thickness > 1 cm (p = 0.0003). CONCLUSIONS: Considering the high incidence of lymph node relapse and the poor survival rate of relapsing patients, we recommend the elective neck dissection to treat all patients with early stage mobile tongue carcinoma.

Keywords : Mobile tongue carcinoma; Neck lymph nodes; Elective treatment; Radiotherapy.

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