Surgery as an Option for Tongue Cancer

Surgical removal of oral cancer produced better recovery rates than chemotherapy alone

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Cancers of the tongue and mouth are among the most common cancers diagnosed by doctors. One new study looked at the effectiveness of several treatment options for these cancers.

The researchers expanded on a recent study that showed promising results in treating cancer of the larynx to include oral cavity cancer. The larynx study used a single dose of chemotherapy to identify patients whose cancer reacted positively to the chemotherapy, allowing them to avoid surgery.

This study found that despite the high success rate of chemotherapy in treating laryngeal cancer, it had a rate of success so low when treating oral cancer that the study had to be terminated earlier than originally planned.

These researchers had hoped to find an alternative treatment to surgery for oral cancer, which can lead to disfigurement and require additional reconstruction surgery.

"Discuss all cancer treatment options with your oncologist."

This study was led by Douglas Chepeha, MD, MSPH, professor of otolaryngology, head and neck surgery at the University of Michigan Medical School.

The study looked at 19 patients with stage III or IV oral cancer of the tongue or surrounding tissue. Each patient was given a single dose of chemotherapy.

The researchers split the patients into two groups. The first group included 10 patients who saw at least a 50 percent reduction in the size of their cancer. This group received additional chemotherapy and radiation treatments.

These researchers placed the remaining nine patients in a group who saw little or no change after their first chemotherapy treatment. These patients had surgery followed by radiation treatment.

The study showed that of the 10 patients in the first group, only three were cancer free after five years.

The second group of patients in the study saw only two cancer free patients after five years. The researchers stopped enrollment in the study early because of these poor results.

The study then looked at a similar group of 53 patients diagnosed with stage III or IV oral cancer of the tongue or surrounding tissue. This group had surgery to remove and reconstruct the afflicted area followed by radiation therapy.

The study showed a much higher rate of survival in the larger group, with 27 of 53 free of cancer after five years.

The researchers concluded that oral cavity cancer treatment had a much higher success rate when surgery was the primary treatment and that diagnostic chemotherapy should not be a treatment option.

"Despite the proven success of this strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery," Dr. Chepeha said.

These researchers explained that using a single diagnostic treatment of chemotherapy when treating cancer of the larynx is a common and successful practice. This study looked at the outcome of using a similar approach to treat oral cavity cancer.

"Surgery followed by radiation and/or chemotherapy had been the standard of care for locally advanced oral cavity cancer. This study tried to identify chemotherapy sensitive patients and eliminate surgery. Unfortunately, this study was closed early due to the patients not receiving surgery doing worse. After this study, surgery is still needed for advanced oral cavity cancer," said Subhakar "Sub" Mutyala, MD, Associate Director of the Baylor Scott & White Cancer Institute and Associate Professor at Texas A&M College of Medicine in Temple, Texas.

"In the future, as chemotherapy and radiation improves, maybe we can spare some patients from surgery but that does not seem to be the case today," Dr. Mutyala told dailyRx News.

This study was funded by University of Michigan, National Cancer Institute SPORE grant and National Institute of Dental and Craniofacial Research grant.

This study was limited by its small size, which was caused by the poor response of the study group to treatment. This poor response triggered predefined rules to stop further testing.

The authors of this study made no disclosures.

This study was first published December 26 in JAMA Otolaryngology Head and Neck Surgery.

Review Date: 
December 26, 2013
Last Updated:
February 19, 2014