Vol. 34, pp , late cervical metastases LCM 3 43 T1 T3N1M0

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1 9 Vol. 34, pp. 936, 006 II III : II TN0III TN1 T3N0 0 TN0 T3N0 levels I, II, III, TN1 levels I, II, III, IV, V 5 60 II 63.6 III 55.6 TN levels I, II, III late cervical metastases LCM 3 43 T3N level V LCM TN1 5 LCM II TN 0 T3N0 II TN0M0 III T3N0M0 T1T3N1M II II IIIII 9

2 II 11 III 9 0 II T cm 4cm N0 M0 TN0 III T3 4cm N0M0 T1 cmt3n1 3cm M0 UICC, 1997 III TN1M0 TN1 T3N0M0 T3N0 T1N1M0 T3N1M T N0 T3N0 TN1 0 mm safety-margin 1 TN0 TN1 en-block pull-through pull-through 3 T3N0 pull-through 4 Pull-through T1T3N0M TN0 T3N0 TN1 1 TN0 T3N0 ACHNSO Academy s Committee for Head and Neck Surgery and Oncology 3 levels I II III 4 3 TN1 ACHNSO levels I II III IV V 4 5 Fig II 63.6 III 55.6 TN0 TN0 11 late cervical metastases LCM Table 1 Case 30

3 IIIII 31 Case 10 LCM 7 6 Fig. 1. Survival curves of the tongue carcinoma according to stage; p stage II n11. stage III n9. 8, 9, 10, 11 T N0 LCM LCM level IIII Case 5, 6, 7 LCM levels IV 50Gy Case 8, 9, 10, 11 TN1 T3N0 5 TN1 Case 15 4 T3N0 Case 69 LCM Table TN1 LCM 4 80 Case 5 Case 1,, 3 Case 4 3 cm advanced-t pullthrough T3N0 pullthrough LCM 3 LCM level IIIIlevel V Table 1. TN0M0 Tongue Carcinoma Cases April 1995March

4 3 Table. TN1M0 or T3N0M0 Tongue Carcinoma Cases April 1995 March IIIII IIIII II 515 II 777 III II 63.6 III 55.6 T1 T wait-and-seepolicy LCM LCM 1 TN0 LCM cm Early-T LCM Weiss 0 LCM LCM 17 N Kligermen 18 N LCM LCM 4 1 p0.05 Salvage

5 IIIII 33 7 p0.04 N0 Vandenbrouck 19 N0 75 Iridium LCM 17 Fakih 0 N TN0 LCM 63 level IIII CT TN0 level IIII N0 level IIII selective neck dissection first echelon cascade theory T3N0 LCM level IIII 51 Texas MD Anderson Cancer Center Byers 3 Leemans 4 cascade-theory 15 level IV 5 T3N0 level II III level IV T3N0 75 LCM T3N0 QOL LCM LCM Byers 6 T1 N0 doublue-dna-aneuploid 4mm IIIII Byers 7 Yuen 8 N0 pn pn 5 neoadjuvant chemotherapynac 5 II 77.8 III 60 III NAC NAC 5930 CR responder non-responder responder NAC prospective study II 11 III 9 33

6 II 63.6 III 55.6 TN0 II LCM T3N0 III TN1 III TN1 5 LCM T3N LCM 1 III JHONS 000; 16: : Robins KT, Medine JE and Wolfe GT. Standardizing neck dissection terminology. Arch Otolaryngol Head Neck Surg 1991; 117: Neoadjuvant Chemotherapy 1998; 101: ; 38: ; 69: ; 78: Stage III, IV 1991; 63: DNA Ploidy Pattern 003; 106: I II JOHNS 000; 16: Stage III, IV 1991; 63: Bradfield JS and Scruggs RP. Carcinoma of the mobile tongue: Incidence of cervical metastases in early lesions related to method of primary treatment. Laryngoscope 1983; 93: Teichgraeber JF and Clairmont AA. The incidence of occult metastases for cancer of the oral tongue and floor of the mouth; Treatment rationale. Head Neck Surgery 1984; 7: Ho CM, Lam KH, Wei WI, Lau SK and Lam LK. Occult lymph node metastases in small oral tongue cancers. Head Neck 199; 14: Haddadin KJ, Soutar DS, Oliver RJ, Webster MH, Robertson AG and MacDonald DG. Improved survival for patients with clinically T1T, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 1999; 1: Weiss MH, Harrison LB and Isaacs RS. Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg 1994; 10: Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ and Olivatto LO. Supraomohyoid neck dissection in the treatment of T1T squamous cell carcinoma of oral cavity. Am J Surg 1994; 168: Vandenbrouck C, Sancho-Garnier H, Chassagne D, Saravane D, Cachin Y and Micheau C. Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cav- 34

7 IIIII 35 ity: results of a randomized clinical trial. Cancer 1980; 46: Fakih AR, Rao RS, Borges AM and Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989; 158: N0 1996; 6: Davidson BJ, Kulkarny V, Delacure MD and Shah JP. Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract. Am J Surg 1993; 166: Byers RM, Weber RS, Andrews T, McGill D, Kare R and Wolf P. Frequency and therapeutic implications of skip metastases in the neck from squamous carcinoma of the oral tongue. Head Neck 1997; 19: Leemans CR and Snows GB. Is selective neck dissection really as e$cacious as modified radical neck dissection for elective treatment of the clinically negative neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts Arch Otolaryngol Head Neck Surg 1998; 14: IIIIV JOHNS 000; 16: Byers RM, El-Naggar AK, Lee YY, Rao B, Fornage B, Terry NH, Sample D, Hankins P, Smith TL and Wolf PJ. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck 1998; 0: Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB and Goepfert H. Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck 1999; 1: Yuen AP, Lam KY, Chan AC, Wei WI, Lam LK, Ho WK and Ho CM. Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma. Am J Surg 1999; 177: Jaulerry C, Rodriguez J, Brunin F, Jouve M, Mosseri V, Point D, Pontvert D, Validire P, Zafrani B and Blaszka B. Induction chemotherapy in advanced head and neck tumors: results of two randomized trials. Int J Radiat Oncol Biol Phys 199; 3: Poulsen M, Aldren C, Tripcony L and Walker Q. Is surgery necessary in stage III and stage IV cancer of the head and neck that responds to induction chemotherapy? Arch Otolaryngol Head Neck Surg 1996; 1:

8 36 Abstract Surgical Treatment for Stage II and Stage III Tongue Carcinoma Is Prophylactic Neck Dissection Necessary in Patients with N0 Tongue Carcinoma? Kouichiro Tsutsumi 1, Shoji Watanabe, Toshiharu Shintani 1, Shigenori Nobukiyo, Takashi Otsuka, Yoshihiro Akazawa, Sonoko Shimada, Kazuteru Suzuki 1, Masaki Aihara 3, Hiromichi Gomi 4, Kenji Takizawa 4, Hirotaka Koizumi 5, and Izumi Koizuka The indication and preferred dissection area for prophylactic neck dissection PND of the clinically negative neck N0 in tongue carcinoma TC are controversial and have not been standardized. We analyzed the e$cacy of surgical treatment in 0 patients with stage II TN0 or stage III TN1 and T3N0 TC. All patients underwent surgical procedure alone as initial treatment in the Departments of Otolaryngology at St. Marianna University School of Medicine from April 1995 to March The TN0 group was treated with a glossectomy G alone. The T3N0 group was treated with a G and a supraomohyoid PND of levels I, II, and III SOH-PND. The TN1 group was treated with a G and a total ND of levels I, II, III, IV, and V TND. The 5-year cumulative survival rate of all 0 patients was 60, with 63.6 in stage II and 55.6 in stage III. In the TN0 group 11 patients, 7 patients 63 had late cervical metastases LCM in levels I, II or III; 3 43 received TND plus post-tnd irradiation and have been alive with no evidence of disease. In the T3N0 group 4 patients, 3 patients 75 had LCM and died of disease; in these patients all the LCM occurred in a previously undissected area level V. In the TN1M0 group 5 patients, all patients did not have LCM; 4 80 have been alive with no evidence of disease, and one showed multiple metastases to lung and died. These results suggest that stage II TN0 and T3N0 TC patients should undergo SOH-PND and TND, respectively. Key Words tongue carcinoma, surgical treatment, prophylactic nec dissection 1 Department of Otolaryngology, Kawasaki Municipal Tama Hospital Department of Otolaryngology, St. Marianna University School of Medicine 3 Department of Plastic Surgery, St. Marianna University School of Medicine 4 Department of Radiology, St. Marianna University School of Medicine 5 Department of Pathology, St. Marianna University School of Medicine 36