Neck Failures in Early Node Negative Carcinoma Tongue (T1 T2 N0): An Emphasis on the Importance of Neck Treatment.

Early node negative carcinoma of the oral tongue (T1T2N0) have excellent local control rates with surgery or radiotherapy. The main area of recurrence is in the neck node which approaches around 15-30%. There is an unanswered question reegarding the management of neck in these subgroup of tumors. We retrospectively reviewed the patients of early carcinoma tongue (T1 T2 N0) from June 2003 to June 2012 treated in our institute. The patterns of local and nodal recurrence were analyzed and the impact of neck treatment was assessed. Total number of patients was 59 with T1 tumors comprising 54.2% and T2 tumors comprising 45.8%. 50 patients underwent biopsy alone and the 9 patients underwent Wide local excision. Neck dissection was done in 6 patients only with 4 patients having SOND and 2 patients having MRND. All patients received brachytherapy (BT) with 40 patients receiving BT alone while 19 patients receiving combination of external beam radiotherapy (EBRT) and BT as boost. In the BT alone group, the 5 year local recurrence free survival (RFS) was 80% and 5 year regional RFS was 70%. In the (EBRT + BT) group, the 5 year local RFS was 77% and 5 year regional RFS was 84%. The total number of patients having neck nodal failures was 15, out of which 10 patients had no previous neck treatment. The 5 year regional RFS in patients without neck treatment was 70% while the 5 year regional RFS in patients with neck treatment was 75% (p = 0.6). Early node negative oral tongue cancers have a good local control rates but have an increased chances of recurrence in neck nodes. Neck failures decreases in patients with neck treatment. Thus, neck should be addressed in the patients with early oral tongue cancers either with neck dissection or neck EBRT, especially in high risk cases.