THE MANAGEMENT OF PATIENTS WITH CARCINOMA OF THE TONGUE

Surgery, radiotherapy or the combination of these two modalities remains the accepted treatment for squamous carcinoma of the tongue. In the 10-year period between 1982 and 1992, 121 patients presented to the combined Maxillofacial/Radiation Oncology Clinic, Royal Infirmary, Edinburgh with carcinoma of the tongue. The majority of T1 tumours have been treated by surgical excision, almost equal numbers of T2 tumours were treated by surgery or radiotherapy, T3 and T4 tumours without evidence of nodal disease were treated by radiotherapy. Patients presenting with established nodal disease or involvement of bone were treated primarily by surgery. The patients presenting with T3 and T4 tumours were combined to produce a more realistic figure for statistical analysis. The actual 5-year survival rates for patients presenting from 1982 to 1987 for T1, T2 and T3/4 tumours are 83%, 63% and 0% respectively. Five year actuarial survival rates for patients from 1987 to 1992 are 89%, 69% and 47%. In the absence of nodal disease in the retrospective group, T1, T2 and T3/4 carcinomas of the tongue have actual 5-year survival rates of 93%, 87% and 0% respectively. Patients who present with or later develop nodal disease have a poorer prognosis with survival rates of 33%, 33% and 0% for T1, T2 and T3/4 tumours. The size of the primary tumour did not significantly affect the five year survival rate when nodal disease was present.