TONGUE CANCER DEBATE

1. LIMITED NECK
SURGERY AND RADIATION
IN TONGUE CANCER
WHOLE NECK

3. Therapeutic delusions
• Which nodes to be addressed in surgery?
• Till what level to be dissected?
• How to address contralateral side?
• Minimum nodes to be addressed?
• Is oral tongue being different from other oral cavity cancers?
• How to address in post operative settings?
• Treat whole neck unilateral?
• Treat bilateral neck?
• Treat limited neck?
• How to address well lateralized lesion?
• Worry about toxicity?

4. Lymphatic
drainage
of tongue

6. Skip
metastasis
in tongue
cancer
Several studies have suggested that the SM is more
common singularity in oral cancers, especially with
SCC of tongue and floor of mouth as there is often
free communication between the two sides of tongue.
The normal acts of mastication and swallowing enable
tongue massage and can encourage both initial and
rapid lymphatic spread directly to low in the neck
Bilateral metastases were seen in some tumours of
the floor of mouth, tongue and oropharynx which
involved the midline.
An erratic distribution of metastases suggestive of
‘fast-tracking’ (skip lesions and peppering) was only
seen in tongue tumours

12. Neck dissection- how many nodes?

13. Neck dissection- cT1cN0

14. Neck dissection- cT2 to cT4, cN0

15. Neck dissection- cT2 to cT4, cN+

16. Neck dissection- contralateral?

17. Adjuvant radiotherapy – N1

18. Adjuvant radiotherapy – N2/3

19. Adjuvant radiotherapy- contralateral

20. Sx vs RT in N0

21. • DAHANCA
• 2020

25. MARIJE R. VERGEER/IJROBP/2009

26. How I treat?
• Two volumes
• High risk volume - 60 Gy
• Primary + 1/2cm margin
• Node-Positive nodal basin
• Low risk volume - 50 Gy
• Primary- whole tongue
• Node-Bilateral subclinical[ uninvolved] node
from level 1-4
• PNE/ Margin close/positive – 66 GY that area

27. Summary
• Tongue is different form other oral cavity cancers
• Skip metastasis are common
• High mobility/mastication contralateral mets are not
uncommon
• It is highly recommended to treat bilaterally even in early stage
• For well lateralized lesions you can unilaterally but carefully

29. Listen to my opponent

30. This fun is not for fun

31. Evidence is clear
I am clear
Opponent is clear
Audience is clear

32. Take care of the tongue
Otherwise, it will show the tongue

33. Conclusion
टग क
े साथ जंग मत करो
नेहितो अपना रंग दीखाईगा