Is glossectomy necessary for late nodal metastases without clinical local recurrence after initial brachytherapy for N0 tongue cancer? A retrospective experience in 111 patients who received salvage therapy for cervical failure

Purpose: To assess the efficacy of neck dissection (ND) without glossectomy (GL) for late nodal metastases without local recurrence after brachytherapy for N0 tongue cancer. Materials and methods: Among 396 patients with N0 tongue cancer treated with brachytherapy, a retrospective analysis was performed in 111 patients who were clinically diagnosed as having nodal metastases without local recurrence and whose neck lymph nodes turned out to be pathologically positive after salvage surgery. One hundred and five patients had undergone only ND (the ND group), six patients had undergone ND with GL (the ND+GL group). Results: The 5 year disease-free and cause-specific survival rates after salvage therapy for the 111 patients included in this study were 58.1 and 61.9%, respectively. In the ND group, there were only nine patients who had local recurrence after ND. In addition, only six patients (5.7%) had a local recurrence within 2 years in the ND group. Sixty-three patients were free of disease after ND, 31 patients had regional or distant metastases without local recurrence and two patients had progressive disease at ND. In the ND+GL group, four patients were alive without disease and two died from regional or distant metastases. None of the patients in the ND+GL group were found to have malignant tissue in the pathological findings from the excised tongue. Conclusion: GL should be avoided or suspended when the clinical evaluation had revealed cervical failure without apparent local recurrence in the mobile tongue cancer patients after initial brachytherapy.