Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T08:31:37.825Z Has data issue: false hasContentIssue false
  • English
  • Français

Are wider surgical margins needed for early oral tongue cancer?

Published online by Cambridge University Press:  19 January 2012

T A Iseli ,
M J Lin ,
A Tsui ,
A Guiney ,
D Wiesenfeld  and
C E Iseli
T A Iseli*
Affiliation:
Division of Otolaryngology, Head and Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
M J Lin
Affiliation:
Division of Otolaryngology, Head and Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
A Tsui
Affiliation:
Division of Pathology, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
A Guiney
Affiliation:
Division of Otolaryngology, Head and Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
D Wiesenfeld
Affiliation:
Division of Oral and Maxillofacial Surgery, Head and Neck Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
C E Iseli
Affiliation:
Division of Otolaryngology, Head and Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
*
Address for correspondence: Dr T A Iseli, Suite 324/55 Flemington Road, North Melbourne, Victoria 3051, Australia Fax: +61 3 90788105 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Traditionally, a 1-cm surgical resection margin is used for early oral tongue tumours.

Methods:

All tumour stage one (n = 65) and stage two (n = 13) oral tongue cancers treated between January 1999 and January 2009 were followed for a median of 38 months (minimum 12 months). The sites of close and involved margins were histologically reviewed.

Results:

Involved and close margins occurred in 14 and 55 per cent of cases, respectively. The number of involved vs clear or close margins was equivalent in tumour stage one (90 vs 82 per cent), node-negative (100 vs 84 per cent) and perineural or lymphovascular invasion (20 vs 21 per cent) cases. Close or involved margins were similarly likely to be posterior (59 per cent) as anterior (41 per cent, p = 0.22), lateral (57 per cent) as medial (43 per cent, p = 0.34), and mucosal (59 per cent) as deep (41 per cent, p = 0.22). Local recurrence occurred in 28 per cent of cases at a median of 12 months, and was more likely in cases with involved (50 per cent) than clear or close margins (25 per cent, p = 0.10). Disease-free survival was worse in involved margins cases (p = 0.002).

Conclusion:

Involved margins are common in early tongue tumours, and are associated with increased local recurrence and worse survival. Close or involved margins occur in all directions and all tumour types. A wider margin may be justified.

Keywords

Oral CavityTongueCarcinoma, Squamous CellSurgical MarginNeoplasm Recurrence, LocalSurgical Procedures, OperativeSurvival
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 3 , March 2012 , pp. 289 - 294
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Robertson, AG, Soutar, DS, Paul, J, Webster, M, Leonard, AG, Moore, KP et al. Early closure of a randomized trial: surgery and post-operative radiotherapy versus radiotherapy in the management of intra-oral tumours. Clin Oncol 1998;10:155–60CrossRefGoogle Scholar
2Brennan, S, Corry, J, Kleid, S, Porceddu, S, Yuen, K, Rischin, D et al. Prospective trial to evaluate staged neck dissection or elective neck radiotherapy in patients with CT-staged T1-2 N0 squamous cell carcinoma of the oral tongue. Head Neck 2010;32:1428–30Google ScholarPubMed
3Bernier, J, Cooper, JS, Pajak, TF, van Glabbeke, M, Bourhis, J, Forastiere, A et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck 2005;27:843–50CrossRefGoogle Scholar
4Gross, ND, Patel, SG, Carvalho, AL, Chu, PY, Kowalski, LP, Boyle, JO et al. Nomogram for deciding adjuvant treatment after surgery for oral cavity squamous cell carcinoma. Head Neck 2008;30:1352–60CrossRefGoogle ScholarPubMed
5Bradley, PJ, MacLennan, K, Brakenhoff, RH, Leemans, CR. Status of primary tumor surgical margins in squamous head and neck cancer: prognostic implications. Curr Opin Otolaryngol Head Neck Surg 2008;15:74–81CrossRefGoogle Scholar
6Meier, J, Oliver, D, Varvares, M. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society member survey. Head Neck 2005;27:952–8CrossRefGoogle ScholarPubMed
7Johnson, RE, Sigman, JD, Funk, GF, Robinson, RA, Hoffman, HT. Quantification of surgical margin shrinkage in the oral cavity. Head Neck 1997;19:281–63.0.CO;2-X>CrossRefGoogle ScholarPubMed
8Greene, FL, Page, DL, Fleming, ID, Fritz, A, Balch, CM, Haller, DG et al. , eds. AJCC Cancer Staging Manual, 6th ed., New York: Springer, 2002CrossRefGoogle Scholar
9DiNardo, LJ, Lin, J, Karageorge, LS, Powers, CN. Accuracy, utility and cost of frozen section margins in head and neck cancer surgery. Laryngoscope 2000;110:1773–6CrossRefGoogle ScholarPubMed
10Jacobs, JR, Ahmad, K, Cassiano, R, Schuller, DE, Scott, C, Laramore, GE et al. Implications of positive surgical margins. Laryngoscope 1993;103:64–8CrossRefGoogle ScholarPubMed
11Woolgar, JA, Triantafyllou, A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol 2005;41:1034–43CrossRefGoogle ScholarPubMed
12Yan, TL, Ko, JY, Change, YL. Involved margin of tongue cancer: the impact of tumor satellites on prognosis. Head Neck 2008;30:845–51Google Scholar
13Slaughter, DP, Southwick, HW, Smejkal, W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer 1953;6:963–83.0.CO;2-Q>CrossRefGoogle ScholarPubMed
14Patel, RS, Goldstein, DP, Guillemaud, J, Bruch, GA, Brown, D, Gilbert, RW et al. Impact of positive frozen section microscopic tumor cut-through revised to negative on oral carcinoma control and survival rates. Head Neck 2010;32:1444–51CrossRefGoogle ScholarPubMed
15Brandwein-Gensler, M, Teixeira, MS, Lewis, CM, Lee, B, Rolnitzky, L, Hill, JJ et al. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Path 2005;29:167–78CrossRefGoogle Scholar