Tongue Cancer Patients Fair Better with Surgery
In a University of Michigan Comprehensive Cancer Center study of 19 individuals with advanced oral cavity cancer, patients received an initial dose of chemotherapy, called induction chemotherapy.
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Patients whose cancer shrunk by half went on to receive additional chemotherapy in combination with radiation treatment.
Patients whose cancer did not respond well underwent surgery followed by radiation. Study authors note that enrollment in the trial was stopped early due to such poor results.
Among participants, 10 patients had a response to chemotherapy. Among them, just 3 had a complete response from the treatment and were cancer-free 5 years later.
Among the 9 patients who had surgery after the induction chemotherapy, only 2 were alive and cancer-free after 5 years. The U of M researchers then looked at a comparable group of patients who had undergone surgery and sophisticated reconstruction followed by radiation therapy, and found substantially better survival rates and functional outcomes.
These findings should serve to raise primary care physicians’ awareness of tongue cancer, says Douglas Chepeha, MD, MSPH, study author and professor of otolaryngology – head and neck cancer at the University of Michigan Medical School. “[Primary care practitioners] should carefully check the mouth for sores when patients come with complaints of mouth pain,” says Chepeha.
“Sores that have been present for more than 2 weeks without resolution need to have a biopsy performed for diagnosis. Any patient who is an active smoker or has quit smoking within the last 15 years should have their mouth examined for sores, and [undergo] a screening non-contrast chest CT during their yearly physical.” In the event a sore in the mouth is identified during a physical exam, the primary care physician should refer the patient to a head and neck surgeon for a diagnostic biopsy, adds Chepeha.
“Treatment decisions for tongue cancer should be made by a multidisciplinary group of physicians, including head and neck surgeons, medical oncologists, and radiation oncologists with head and neck specialty training,” he says. In this study, researchers found the survival, speech, and swallowing outcomes were worse for patients who underwent induction chemotherapy, notes Chepeha. As such, “when talking with patients, [primary care practitioners] should understand that surgery is an important component for curing and maintaining the remaining function of tongue cancer patients.”
Primary care physicians and patients should also be aware that “reconstruction is an important component, and the patient should be treated within programs that use advanced reconstructive techniques,” he says.
“The discussion about tongue cancer is similar to the discussion that a family physician may have with breast cancer patients. Surgery is an important component, and, in addition, patients may undergo radiation and/or chemotherapy. Reconstruction is an important consideration to restore body image after treatment.”
Chinn S, Spector M, et al. Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients With Advanced Oral Cavity Carcinoma. JAMA Otolaryngology Head and Neck Surgery. 2013.