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Base of Tongue Cancers
Continuum Cancer Centers of New York (CCCNY) has been a national leader in developing intensive treatment programs for patients with head and neck cancers that coordinate the use of radiation, chemotherapy and surgery. This multidisciplinary team approach has dramatically improved the control of cancer in these patients. Because head and neck cancers affect vital functions like speech and swallowing, preserving quality of life is another critical goal of treatment.
Delivering high doses of radiation is essential to eliminating cancer and preventing its recurrence (maintaining local control). Local control reduces the risk of metastasis but does not eliminate it, since surgery and radiation doesn’t reach cancer implants that have spread through the bloodstream. Chemotherapy, which makes radiation more effective at local control, is necessary to treat metastases. Higher stage cancers have more cancer in the neck and a greater chance of metastases.
Each head and neck cancer site poses individual challenges to the treating team. Treating cancers at the base of the tongue with high-dose radiation, along with chemotherapy and surgery when needed, has dramatically improved local control, metastases and survival. However, key muscles in swallowing, the pharyngeal constrictor muscles, can be damaged as "innocent bystanders" of standard radiation treatments, even using the high-tech "dose painting" IMRT (intensity-modulated radiation therapy) approach. We have pioneered the use of radioactive "seeds," also known as brachytherapy, which can give high doses of radiation to a small area. When carefully placed, they irradiate the tumor but not the normal organs nearby.
We recently looked at the outcomes of patients treated by this approach from July 1998 through June 2009. Although the great majority (82%) had Stage IV cancers, which have the highest risk and require the most intensive treatment, the results were remarkable.
The treatment of cancer was highly successful. By three years after treatment, local control (no return of cancer at the original location) was 97%, and so far there have been no further local recurrences (Figure 1). Including cancer recurrence in nearby lymph nodes, locoregional cancer control was 93% at three years (Figure 2). When metastases were added in, disease-free survival (no evidence of cancer anywhere) was 88% at three years (Figure 3).As expected, nearly every recurrence occurred in the high risk Stage IV patients (Figure 4).
The quality of life outcomes, which we were trying to improve by using the more localized brachytherapy approach, were also very good, despite the high radiation doses required to keep the cancer under control. Only 4% of patients were unable to resume eating and required a feeding tube long term, and only 5% had problems with producing saliva (xerostomia) that markedly changed their sense of taste or required that they change their diet.
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