Management of T1 Carcinoma of the Anterior Aspect of the Tongue

The control of carcinoma of the anterior aspect of the tongue is closely related to the extent of the primary tumor and the state of the regional lymph nodes. The most important prognostic factor is the status of cervical lymph nodes; these lymphatic beds should be considered for treatment even in patients who do not have clinically detectable nodal metastasis. Generally, patients with small localized tumors less than 2 cm in diameter (T1) are treated with surgery alone or with radiation therapy alone. In our series, local control was effective in greater than 90% of patients. Treatment failures were most common in the cervical nodes; only 40% of patients with recurrent cervical disease could be cured. The size and differentiation of the lesion, as well as the adequacy of surgical margins, appeared to be related to regional failures. Guidelines are suggested that may aid in selecting patients with T1NO lesions who require elective neck treatment with irradiation.