Surgery beats chemotherapy for tongue cancer, U-M study finds

Patients with tongue cancer who started their treatment with a course of chemotherapy fared significantly worse than patients who received surgery first, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

This is contrary to protocols for larynx cancer, in which a single dose of chemotherapy helps determine which patients fare better with chemotherapy and radiation and which patients should elect for surgery. In larynx cancer, this approach, which was pioneered and extensively researched at U-M, has led to better patient survival and functional outcomes.

But this new study, which appears in JAMA Otolaryngology Head and Neck Surgery, describes a clear failure.

"To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction. 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," says study author Douglas Chepeha, M.D., MSPH, professor of otolaryngology – head and neck surgery at the University of Michigan Medical School.

The study enrolled 19 people with advanced oral cavity cancer. Patients received an initial dose of chemotherapy, called induction chemotherapy. Those whose cancer shrunk by half went on to receive additional chemotherapy combined with radiation treatment. Those whose cancer did not respond well had surgery followed by radiation.

Enrollment in the trial was stopped early because results were so poor.

As the name implies, tongue cancer is a cancer of the tongue. Depending on where the cancer is located on the tongue, it can fall into one of two categories: oral cavity cancer or oropharyngeal cancer. If the cancer is in the two-thirds of the tongue that is towards the front, it is considered oral cavity cancer. Alternatively, if it is in back third of the tongue, it is called oropharyngeal cancer. One in 348 people will be affected by tongue cancer at some point; however, the key to combating it is early detection and awareness of tongue cancer symptoms.

Oral cavity cancer is not only cancer of the tongue, but also the lips, cheeks, hard palate, floor of mouth, minor salivary glands, and gums. It can spread from one part to another, so it is important to be aware of the symptoms of oral cavity cancer in all of its forms, including tongue cancer symptoms. Some symptoms are quite evident while others are a little less obvious.

One of the main tongue cancer symptoms is a patch or several patches of red or white on the tongue. The patches can also be found on the lining of the mouth or the gums. Some people who experience tongue cancer symptoms have problems swallowing or chewing their food, while others have a persistent sore throat. Other signs of tongue cancer include abnormal bleeding in the mouth, sores in the mouth or tongue, lumps on the tongue or in the mouth, a change in the sound of the voice, earaches, and alterations in the way that dentures fit inside the mouth.