For the treatment of cancer, many would consider chemotherapy to be the best option. But for tongue cancer, new research suggests that surgery may be the most effective primary port of call. This is according to a study published in the journal JAMA Otolaryngology Head and Neck Surgery.
The main treatment options for people with oral and oropharyngeal cancers include surgery (partial or full removal of the tongue for tongue cancer, followed by extensive reconstruction), radiation therapy, chemotherapy, targeted therapy and palliative treatment. These can be used alone or in combination.
But researchers from the University of Michigan Comprehensive Cancer Center, including Dr. Douglas Chepeha of the University of Michigan Medical School, say patient outcomes may be improved if surgery was used as the first treatment option.
"To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction," says Dr. Chepeha.
"But patients with oral cavity cancer can't tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation. Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes."
Poor patient outcomes with induction chemotherapy
To reach their findings, the researchers first analyzed 19 patients who had advanced oral cavity cancer.
All of the patients had induction chemotherapy. Patients with a poor response to the chemotherapy then had surgery followed by radiation treatment, while patients whose cancer reduced by 50% had additional chemotherapy in combination with radiation treatment.
Of 10 patients who had a response to chemotherapy, only three had a full response and were free of the cancer 5 years after treatment.
Of the other nine patients who received surgery following induction chemotherapy, only two were free of the cancer and alive after 5 years.
The investigators then analyzed a comparable group of patients, all of whom had surgery as their initial treatment followed by radiation therapy. This group saw much better survival rates and functional outcomes, according to the researchers.
The research team says the findings oppose protocols for treatment for laryngeal cancer, in which they say one dose of chemotherapy can help doctors find out which patients respond better to chemotherapy and radiation, and which patients may have better outcomes with surgery.
The investigators note that for laryngeal cancer, induction chemotherapy usually leads to better patient survival and functional outcomes, as discovered by their own previous research. But they say their findings show this is not the case for tongue cancer.
Dr. Chepeha explains:
"The mouth is a very sensitive area. We know the immune system is critical in oral cavity cancer, and chemotherapy suppresses the immune system. If a person is already debilitated, they don't do well with chemotherapy.
Despite the proven success of this strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery."
Earlier this year, Medical News Today reported on a study suggesting that people with dental cavities have a lower risk of being diagnosed with head and neck cancer , compared to those with few or no dental cavities.