gms | German Medical Science

Introduction: Early floor of the mouth cancer is primarily treated surgically. It is generally accepted that a risk of occult cervical metastases >20% is an indication for elective neck dissection (ND). The goal of this paper was to report about the results of primary surgical treatment and to prove the benefit of an elective ND in the clinically negative neck (cN0).

Methods: A retrospective analysis was carried out, including 216 patients (median age: 52.9), who were treated between 1980 and 2010 due to a pT1/2 floor of the mouth cancer (pT1, n=122; pT2: n=94). The 5-year disease specific survival (DSS) according to Kaplan- Meier and the locoregional tumor control (LRC) according to T- and N- classification was investigated.

Results: In 209 cases a R0 resection (R0 in pT1: n=119; R0 in pT2: n=90) and in 5 cases a R1 status was achieved (Rx: n=2). In 165 patients a ND was performed. In 124 cases an adjuvant therapy was carried out. 90 patients were staged cN0 (pT1: n=62; pT2: n=28) and in 48 of these cases (pT1: n=29; pT2: n=19) an elective ND was performed. The risk of occult metastases was 3.4% (pN1: n=1) in case of pT1 and 26.3% (pN1: n=4; pN2: n=1) in case of pT2. DSS of all patients was 79.5%, LRC 89.8%. DSS of 84.6% for pN0 was significantly higher than a DSS of 60% in case of pN+ (p=0.001). The T- status showed significant impact on DSS (pT1=86.5% and pT2=70.9%; p=0.002).

Conclusion: The primarily surgical treatment of pT1/pT2 floor of the mouth cancer provides acceptable oncologic results. In pT2 cancer a standardized ND should be carried out. In case of pT1 the clinical negative neck can be managed by a wait and scan strategy.