Besides and Beyond Histopathology; for Adjuvant Treatment in Early Tongue Cancer

Abstract

Oral tongue squamous cell carcinomas differ significantly from that of other subsites of oral cavity in relation to clinical behavior. They are more aggressive and have a poorer prognosis. The treatment of choice of early (stage I and II) tongue cancers is surgery. The need for adjuvant treatment is decided on the basis of the histopathology report of the surgical specimen. High-risk patients (positive surgical margins, perineural invasion, lymphovascular spread, lymph node metastasis, and extracapsular extension) receive adjuvant treatment while others are observed. Unfortunately, in the apparently low-risk patients who are observed, there is a high rate of locoregional failure. There are certain histopathology parameters though not routinely validated may be of prognostic significance in this subset of patients. In this review, we have highlighted the importance of the routinely validated and the nonvalidated histopathology parameters and their proper assessment in the decision-making for adjuvant treatment of patients with early tongue cancers.

Keywords

Adjuvant therapy in tongue cancers - early squamous cell carcinoma tongue - indications for radiotherapy in tongue cancers - molecular markers in tongue cancers

Publication History

Article published online:
17 June 2021

• References

• 1 Prince S, Bailey BM. Available from: https://www.google.co.in/search?q=Prince+S%2C+Bailey+BM+Squamous+carcinoma+of+the+tongue%3A+Review+Br+J+Oral+Maxillofac+Surg+1999%3B37%3A164%E2%80%9174&rlz=1C1LENP_enUS715US715&oq=Prince+S%2C+Bailey+BM+Squamous+carcinoma+of+the+tongue%3A+Review+Br+J+Oral+Maxillofac+Surg+1999%3B37%3A164%E2%80%9174&aqs=chrome69i571574j0j4&sourceid=chrome&ie=UTF-8. [Last cited on 2017 Nov 29] Squamous carcinoma of the tongue: Review. Br J Oral Maxillofac Surg 1999; 37: 164-74
• 2 Shemen LJ, Klotz J, Schottenfeld D, Strong EW. Increase of tongue cancer in young men. JAMA 1984; 12: 252-1857
• 3 Depue RH. Rising mortality from cancer of the tongue in young white males. N Engl J Med 1986; 315: 647
• 4 Davis S, Severson RK. Increasing incidence of cancer of the tongue in the United States among young adults. Lancet Lond Engl 1987; 2: 910-1
• 5 Rusthoven K, Ballonoff A, Raben D, Chen C. Poor prognosis in patients with stage I and II oral tongue squamous cell carcinoma. Cancer 2008; 112: 345-51
• 6 Han JM, Wu GH, Zeng ZY, Chen FJ, Chen WK, Li H. et al. Postoperative recurrence-related factors of 125 patients with cT1-2N0 squamous cell carcinoma of the oral tongue. Ai Zheng Aizheng Chin J Cancer 2007; 26: 661-5
• 7 An SY, Jung EJ, Lee M, Kwon TK, Sung MW, Jeon YK. et al. Factors related to regional recurrence in early stage squamous cell carcinoma of the oral tongue. Clin Exp Otorhinolaryngol 2008; 1: 166-70
• 8 Sopka DM, Li T, Lango MN, Mehra R, Liu JC-J, Burtness B. et al Dysplasia at the margin? Investigating the case for subsequent therapy in “low-risk” squamous cell carcinoma of the oral tongue. Oral Oncol 2013; 49: 1083-7
• 9 Mantsopoulos K, Psychogios G, Künzel J, Waldfahrer F, Zenk J, Iro H. Primary surgical therapy for locally limited oral tongue cancer. BioMed Res Int 2014; 2014: 738716
• 10 Yanamoto S, Yamada S, Takahashi H, Kawasaki G, Ikeda H, Shiraishi T. et al. Predictors of locoregional recurrence in T1-2N0 tongue cancer patients. Pathol Oncol Res POR 2013; 19: 795-803
• 11 Chen TY, Emrich LJ, Driscoll DL. The clinical significance of pathological findings in surgically resected margins of the primary tumor in head and neck carcinoma. Int J Radiat Oncol Biol Phys 1987; 13: 833-7
• 12 Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 1990; 160: 410-4
• 13 Woolgar JA, Triantafyllou A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol 2005; 41: 1034-43
• 14 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
• 15 Head-and-neck.pdf [Internet]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. [Last cited on 2017 Nov 29].
• 16 Grégoire V, Lefebvre JL, Licitra L, Felip E. EHNS-ESMO-ESTRO Guidelines Working Group Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol 2010; 21 Suppl 5: v184-6
• 17 Yuen AP, Lam KY, Wei WI, Lam KY, Ho CM, Chow TL. et al A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma. Am J Surg 2000; 180: 139-43
• 18 Woolgar JA. Carcinoma of the tongue: pathological considerations in management of the neck. J R Soc Med 1996; 89: 661-5
• 19 Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997; 19: 205-10
• 20 Brown B, Barnes L, Mazariegos J, Taylor F, Johnson J, Wagner RL. Prognostic factors in mobile tongue and floor of mouth carcinoma. Cancer 1989; 64: 1195-202
• 21 Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989; 158: 309-13
• 22 Thiagarajan S, Nair S, Nair D, Chaturvedi P, Kane SV, Agarwal JP. et al. Predictors of prognosis for squamous cell carcinoma of oral tongue. J Surg Oncol 2014; 109: 639-44
• 23 Ganly I, Goldstein D, Carlson DL, Patel SG, O'Sullivan B, Lee N. et al Long-term regional control and survival in patients with “low-risk,” early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness. Cancer 2013; 119: 1168-76
• 24 Lydiatt DD, Robbins KT, Byers RM, Wolf PE. Treatment of stage I and II oral tongue cancer. Head Neck 1993; 15: 308-12
• 25 Fagan JJ, Collins B, Barnes L, D'Amico F, Myers EN, Johnson JT. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998; 124: 637-40
• 26 Katz O, Nachalon Y, Hilly O, Shpitzer T, Bachar G, Limon D. et al. Radiotherapy in early-stage tongue squamous cell carcinoma with minor adverse features. Head Neck 2017; 39: 147-50
• 27 Larsen SR, Johansen J, Sørensen JA, Krogdahl A. The prognostic significance of histological features in oral squamous cell carcinoma. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol 2009; 38: 657-62
• 28 Close LG, Brown PM, Vuitch MF, Reisch J, Schaefer SD. Microvascular invasion and survival in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 1989; 115: 1304-9
• 29 Broders AC. Squamous cell epithelioma of the lip. JAMA 1920; 74: 656-64 Available from: https://www.google.co.in/search?rlz=1C1LENP_enUS715US715&ei=ud4eWuD6NcnWvgTtzJ-YBw&q=Broders+AC.+Squamous+cell+epithelioma+of+the+lip.+JAMA+1920%3B74%3A656%E2%80%9164&oq=Broders+AC.+Squamous+cell+epithelioma+of+the+lip.+JAMA+1920%3B74%3A656%E2%80%9164&gs_l=psy-ab.3...10924.11426.0.12310.2.2.0.0.0.0.241.383.0j1j1.2.0....0...1c.1.64.psyab..0.0.0....0.kTxJWhoOPRA. [Last cited on 2017 Nov 29].
• 30 Jakobsson PA, Eneroth CM, Killander D, Moberger G, Mårtensson B. Histologic classification and grading of malignancy in carcinoma of the larynx. Acta Radiol Ther Phys Biol 1973; 12: 1-8
• 31 Anneroth G, Batsakis J, Luna M. Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas. Scand J Dent Res 1987; 95: 229-49
• 32 Bryne M, Koppang HS, Lilleng R, Stene T, Bang G, Dabelsteen E. New malignancy grading is a better prognostic indicator than Broders' grading in oral squamous cell carcinomas. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol 1989; 18: 432-7
• 33 Bryne M, Koppang HS, Lilleng R, Kjaerheim A. Malignancy grading of the deep invasive margins of oral squamous cell carcinomas has high prognostic value. J Pathol 1992; 166: 375-81
• 34 Spiro RH, Guillamondegui O, Paulino AF, Huvos AG. Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 1999; 21: 408-13
• 35 Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH. et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?. Head Neck 1998; 20: 138-44
• 36 Hemmer J, Schön E, Kreidler J, Haase S. Prognostic implications of DNA ploidy in squamous cell carcinomas of the tongue assessed by flow cytometry. J Cancer Res Clin Oncol 1990; 116: 83-6
• 37 Valente G, Orecchia R, Gandolfo S, Arnaudo M, Ragona R, Kerim S. et al. Can Ki67 immunostaining predict response to radiotherapy in oral squamous cell carcinoma?. J Clin Pathol 1994; 47: 109-12
• 38 Yan J, Jiang Y, Ye M, Liu W, Feng L. The clinical value of lymphatic vessel density, intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 expression in patients with oral tongue squamous cell carcinoma. J Can Res Ther 2014; 10: 125-30
• 39 Chen FH, Chiang CS, Wang CC, Tsai CS, Jung SM, Lee CC. et al. Radiotherapy decreases vascular density and causes hypoxia with macrophage aggregation in TRAMP-C1 prostate tumors. Clin Cancer Res Off J Am Assoc Cancer Res 2009; 15: 1721-9
• 40 Hegde PU, Brenski AC, Caldarelli DD, Hutchinson J, Panje WR, Wood NB. et al. Tumor angiogenesis and p53 mutations: prognosis in head and neck cancer. Arch Otolaryngol Head Neck Surg 1998; 124: 80-5
• 41 Atula S, Kurvinen K, Grénman R, Syrjänen S. SSCP pattern indicative for p53 mutation is related to advanced stage and high-grade of tongue cancer. Eur J Cancer B Oral Oncol 1669; 32: 222-9
• 42 Sameshima Y, Matsuno Y, Hirohashi S, Shimosato Y, Mizoguchi H, Sugimura T. et al. Alterations of the p53 gene are common and critical events for the maintenance of malignant phenotypes in small-cell lung carcinoma. Oncogene 1992; 7: 451-7
• 43 Pohl J, Goldfinger N, Radler-Pohl A, Rotter V, Schirrmacher V. p53 increases experimental metastatic capacity of murine carcinoma cells. Mol Cell Biol 1988; 8: 2078-81
• 44 Kantola S, Parikka M, Jokinen K, Hyrynkangs K, Soini Y, Alho OP. et al. Prognostic factors in tongue cancer - relative importance of demographic, clinical and histopathological factors. Br J Cancer 2000; 83: 614-9
• 45 Dahlgren L, Dahlstrand HM, Lindquist D, Högmo A, Björnestål L, Lindholm J. et al. Human papillomavirus is more common in base of tongue than in mobile tongue cancer and is a favorable prognostic factor in base of tongue cancer patients. Int J Cancer 2004; 112: 1015-9
• 46 Liang K, Ang KK, Milas L, Hunter N, Fan Z. The epidermal growth factor receptor mediates radioresistance. Int J Radiat Oncol Biol Phys 2003; 57: 246-54
• 47 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; 354: 567-78
• 48 Kim SH, Cho NH, Kim K, Lee JS, Koo BS, Kim JH. et al. Correlations of oral tongue cancer invasion with matrix metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) expression. J Surg Oncol 2006; 93: 330-7
• 49 Sharma P, Shah SV, Taneja C, Patel AM, Patel MD. A prospective study of prognostic factors for recurrence in early oral tongue cancer. J Clin Diagn Res JCDR 2013; 7: 2559-62
• 50 Srivastava RM, Lee SC, Andrade Filho PA, Lord CA, Jie HB, Davidson HC. et al. Cetuximab-activated natural killer and dendritic cells collaborate to trigger tumor antigen-specific T-cell immunity in head and neck cancer patients. Clin Cancer Res Off J Am Assoc Cancer Res 2013; 19: 1858-72
• 51 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
• 52 Ferris RL, Blumenschein G, Fayette J, Guigay J, Colevas AD, Licitra L. et al. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med 2016; 375: 1856-67