This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.
A retrospective review of 202 patients with supraglottic squamous cell carcinoma and at least 2 years of follow-up was performed. Surgery alone was used to treat 102 patients, and combined therapy in 100 patients. Local-regional failure occurred in 47 (23%) patients. Only 4 patients (2%) developed recurrence at the primary site. The neck was the most common site for recurrent disease (39/47 or 83%), which in 35 patients appeared in the undirected, contralateral side. The risk to the contralateral side of the neck in patients with midline (epiglottic) lesions was similar to that in those with unilateral (aryepiglottic fold) lesions. Supraglottic laryngectomy, when properly selected, did not compromise primary control in the larynx. Radiation therapy was ineffective in controlling metastasis to the contralateral side of the neck in 16 of 99 patients (16 %). Therefore, routine bilateral neck dissection should be considered in the surgical treatment of supraglottic carcinoma for control of regional disease.
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