gms | German Medical Science

Introduction: The aims of this investigation were to evaluate the effectiveness of organ preserving carbon dioxide laser microsurgery for the treatment of squamous cell carcinomas of the base of the tongue, and to assess the effect of this therapy on the postoperative swallowing und speech function.

Methods: A retrospective review of 75 patients undergoing primary carbon dioxide laser microsurgery between 1986 and 2001 for the treatment of squamous cell carcinoma of the base of tongue was undertaken. Exclusion criteria included: simultaneous tumor, previous treatment for cancer, distant and N3 neck disease. The distribution of the T categories were as follows: pT1, n=1; pT2, n=20; pT3, n=8 and pT4, n=46. Ninety-two per cent patients had stage III or IVa disease. Ninety one percent patients underwent additional uni- or bilateral neck dissection, and 53% received postoperative radio(chemo)therapy.

Results: Eleven patients (15%) developed local recurrence. The 5-year overall and recurrence-free Kaplan-Meier survival rates were 57% and 72%, respectively. Metachronous distant metastases appeared in 8%, and second primary tumors in 17%. Within one year after therapy 73% patients had achieved undisturbed oral intake, 16% could only eat pulpy food or had occasional aspiration. Eight patients (11%) required a gastrostomy tube for feeding purposes. No patient had to undergo laryngectomy or needed a permanent tracheostomy. The mean performance status scale scores of 25 patients at the moment of the investigation was 88% for normalcy of diet and 92% for understandability of speech.

Conclusion: The oncological results are comparable with those of other therapeutic options. The good functional results of laser microsurgery favor this kind of surgery for the treatment of carcinomas of the base of the tongue in selected patient.