Salvage Surgery for Locoregional Failure after Definitive Radiotherapy for Base of Tongue Cancer

Abstract

In this study, the results of definitive radiotherapy (RT) and salvage surgery treatment of base of tongue cancer were evaluated. A total of 94 consecutive patients (16 female and 78 male) with T1-4, N0-3 and M0 disease underwent definitive RT between 1992 and 2005. External beam RT alone (mean dose, 63 Gy) or external beam RT (mean dose 61 Gy) with brachytherapy boost (mean dose, 17 Gy) was given for 50 and 44 patients, respectively. Eight patients were subjected to neck node dissection, generally at the time of brachytherapy. At a median follow-up time of 95 months, 37 (39%) patients had no residual disease or locoregional recurrence, 34 (36%) patients had locoregional residual disease and 23 (25%) patients developed locoregional recurrence. The 5-year cause-specific survival for all patients was 45% (43 of 94). In multivariate analysis, N2-3 stage and histological grade 3 proved to be independent negative predictors of cause-specific survival (relative risk: 2.2 and 3.1, respectively). The overall number of patients with locoregional failure was 57. Salvage surgery was possible in 18 (32%) patients; more than half of the patients (31of 57) with locoregional failure were not suitable for salvage surgery due to unresectable disease, poor health status or distant metastasis. Salvage surgery was successful in 10 (56%) patients, while 8 patients developed a second locoregional recurrence. For patients undergoing definitive RT, more effective follow-up and care is needed to increase the rate of salvage surgery.