Indian Council of Medical Research consensus document for the management of tongue cancer

E X E C U T I V E S U M M A R Y

The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India. Early diagnosis is imperative in improving outcomes and preserving quality of life. High index of suspicion is to be maintained for leukoplakia (high risk site). Evaluation of a patient with newly diagnosed tongue cancer should include essential tests: Magnetic resonance imaging (MRI) is investigative modality of choice when indicated. Computed tomography (CT) scan is an option when MRI is unavailable. In early lesions when imaging is not warranted ultrasound may help guide management of the neck. Early stage cancers (stage I & II) require single modality treatment - either surgery or radiotherapy. Surgery is preferred. Adjuvant radiotherapy is indicated for T3/T4 cancers, presence of high risk features [lymphovascular emboli (LVE), perineural invasion (PNI), poorly differentiated, node +,close margins). Adjuvant chemoradiation (CTRT) is indicated for positive margins and extranodal disease. Locally advanced operable cancers (stage III & IVA) require combined multimodality treatment - surgery + adjuvant treatment. Adjuvant treatment is indicated in all and in the presence of high risk features as described above. Locally advanced inoperable cancers (stage IVB) are treated with palliative chemo-radiotherapy, chemotherapy, radiotherapy, or symptomatic treatment depending upon the performance status. Select cases may be considered for neoadjuvant chemotherapy followed by surgical salvage. Metastatic disease (stage IVC) should be treated with a goal for palliation. Chemotherapy may be offered to patients with good performance status. Local treatment in the form of radiotherapy may be added for palliation of symptoms. Intense follow-up every 3 months is required for initial 2 years as most recurrences occur in the first 24 months. After 2 nd year follow up is done at 4-6 months interval. At each follow up screening for local/ regional recurrence and second primary is done. Imaging is done only when indicated.

Keywords

Tongue cancer - Guidelines - ICMR

Publication History

Article published online:
12 July 2021

• References

• 1 National Cancer Registry Programme, Indian Council of Medical Research: Three-Year Report of the Population Based Cancer Registries: 2009-2011. Available from: Http://www.pbcrindia.org/. [Last accessed on 2015 Jan 16].
• 2 NCCN Guidelines Version 1.2014, Cancer of the Oral Cavity, National Comprehensive Cancer Care Clinical Practice Guidelines in Oncology (NCCN Guidelines). Available at: http://www.NCCN.org. [Last accessed on 2015 Jan 16].
• 3 Yorkshire Cancer Network (YCN) Head and Neck Cancer Treatment Guidelines Version 4. 2014. (NHS Guidelines). Available at: http://www.ycn.nhs.uk. [Last accessed on 2015 Jan 16].
• 4 Pivot X, ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of squamous cell carcinoma of the head and neck. Ann Oncol 2003;14:1014-5.
• 5 D′Cruz AK, Chaukar D, Gupta T, Agarwal JP, Prabhash K, Laskar S, et al. Evidence based managemnet of cancers in India: Guidelines for Head Neck cancers Vol XI. Mumbai: Tata Memorial Centre; 2012.
• 6 Huang SH, Hwang D, Lockwood G, Goldstein DP, O′Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: A meta-analysis of reported studies. Cancer 2009;115:1489-97.
• 7 Quon A, Fischbein NJ, McDougall IR, Le QT, Loo BW Jr, Pinto H, et al. Clinical role of 18F-FDG PET/CT in the Management of squamous cell carcinoma of the head and neck and thyroid carcinoma. J Nucl Med 2007;48 (Suppl 1):58S-67S. PMID: 17204721.
• 8 Schöder H, Carlson DL, Kraus DH, Stambuk HE, Gönen M, Erdi YE, et al 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med 2006;47:755-62.
• 9 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7 th ed. New York: Springer; 2010.
• 10 Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P. Frequency and therapeutic implications of "skip metastases" in the neck from squamous carcinoma of the oral tongue. Head Neck 1997;19:14-9.
• 11 Pantvaidya GH, Pal P, Vaidya AD, Pai PS, D′Cruz AK. Prospective study of 583 neck dissections in oral cancers: Implications for clinical practice. Head Neck 2014;36:1503-7.
• 12 Singh B, Nair S, Nair D, Patil A, Chaturvedi P, D′Cruz AK. Ipsilateral neck nodal status as predictor of contralateral nodal metastasis in carcinoma of tongue crossing the midline. Head Neck 2013;35:649-52.
• 13 Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945-52.
• 14 Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937-44.
• 15 Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-50.
• 16 Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006 9;354:567-78.
• 17 Petrelli F, Coinu A, Riboldi V, Borgonovo K, Ghilardi M, Cabiddu M, et al. Concomitant platinum-based chemotherapy or cetuximab with radiotherapy for locally advanced head and neck cancer: A systematic review and meta-analysis of published studies. Oral Oncology 2014;50:1041-48.
• 18 Agarwal JP, Nemade B, Murthy V, Ghosh-Laskar S, Budrukkar A, Gupta T, et al. Hypofractionated, palliative radiotherapy for advanced head and neck cancer. Radiother Oncol 2008;89:51-6.
• 19 Patil VM, Noronha V, Joshi A, Muddu VK, Gulia S, Bhosale B, et al. Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference? Indian J Cancer 2013;50:1-8.
• 20 Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-27.