Japanese Journal of Clinical Oncology Advance Access published online on February 12, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp001
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© The Author (2009). Published by Oxford University Press. All rights reserved
Metastatic Neck Disease Beyond the Limits of a Neck Dissection: Attention to the ‘Para-hyoid’ Area in T1/2 Oral Tongue Cancer
1 Head and Neck Surgery Division, National Cancer Center Hospital, Tokyo
2 Department of Otorhinolaryngology, School of Medicine, University of Tokyo, Tokyo
3 Division of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
For reprints and all correspondence: Mizuo Ando, Department of Otorhinolaryngology, School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: andom-tky{at}umin.ac.jp
Received September 7, 2008; accepted December 31, 2008
Objective: We evaluated patients with small oral tongue cancer suffering from recurrence, which develops in the intervening area between the primary site and the neck. Lesions in the area around the cornu of the hyoid bone (‘para-hyoid’ area) often involve the hypoglossal nerve and the root of the lingual artery, resulting in treatment failure and death.
Methods: A 10-year retrospective chart review was conducted of 248 oral tongue cancer patients with small primary tumors (T1/2). No patients who underwent postoperative radiotherapy (PORT) were included.
Results: After excluding those who had local failure or developed new primary lesions, 6.3% of the patients were noted to have a para-hyoid lesion. A similar incidence was observed between the patients with and without previous neck dissection, 6.9% and 5.7%, respectively. All but one patient died due to uncontrolled neck disease.
Conclusions: Recurrent para-hyoid lesions could occur, irrespective of a previous neck dissection. In other words, the para-hyoid area is beyond the limits of a neck dissection. Once a para-hyoid lesion becomes clinically evident, it seems difficult to salvage. Therefore, a careful inspection of the area should be included intraoperatively in any type of neck dissection (i.e. elective or therapeutic) for patients with oral tongue cancer. This may be the key to improving the regional control rate of patients with small oral tongue cancer. We believe that some patients will benefit from more aggressive treatment of the neck, although PORT seems unnecessary for the majority of the patients with limited neck disease.
Key Words: head and neck • squamous cell carcinoma • tongue • neck dissection