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Bradley A. Schiff, MD; Dianna B. Roberts, PhD; Adel El-Naggar, MD, PhD; Adam S. Garden, MD; Jeffrey N. Myers, MD, PhD

Arch Otolaryngol Head Neck Surg. 2005;131:874-878.

Objectives  To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks.

Design  Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years.

Setting  The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital.

Patients  A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence.

Interventions  All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well.

Main Outcome Measures  Clinical and pathological nodal status, type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates.

Results  For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P = .07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P = .24).

Conclusions  Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.

Author Affiliations: Departments of Head and Neck Surgery (Drs Schiff, Roberts, El-Naggar, and Myers), Radiation Oncology (Dr Garden), and Pathology (Dr El-Naggar), The University of Texas M. D. Anderson Cancer Center, Houston; and Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Dr Schiff).