Oral Radiology

, Volume 8, Issue 1, pp 1–9 | Cite as

A preliminary and clinical study of radiation therapy for tongue carcinoma

  • Kwang Joon Koh
  • Hiroshi Ikeda
  • Kimishige Shimizutani
  • Toshihiko Inoue
  • Souhei Furukawa
  • Kazuko Kubo
  • Hajime Fuchihata
Original Articles


Four hundred and seventy-four patients with squamous cell carcinomas of the tongue were treated with radiation therapy at the Department of Radiology, Osaka University Hospital between 1978 and 1987.

Brachytherapy was mainly employed for the majority of the patients with T1 and T2 lesions, whereas the combination of external irradiation and brachytherapy was the treatment of choice for the patients with infiltrative T2 and more advanced lesions. Patients treated with brachytherapy alone were given an estimated tumor dose of about 70Gy within a week. Patients treated with the combined therapy received an estimated tumor dose of about 30Gy to 50Gy within 3 to 5 weeks from external irradiation, followed by 50Gy to 60Gy within a week from brachytherapy.

The treatments used in this study improved the survival. The 2-year local control rates were 85% in T1, 77% in T2, 60% in T3 and 33% in T4 lesions. The 5-year actuarial survival rates according to the T stage were 78% in T1, 64% in T2, 50% in T3 and 40% in T4 lesions.

One hundred and four patients(28%) of three hundred and sixty nine patients who had negative lymph nodes clinically had cervical lymph node metastases subsequently. Whereas twenty six patients(25%) of one hundred and five patients who had positive lymph nodes clinically proved to be false positive.

The incidence of osteoradionecrosis was 6.0% in patients treated with the combination of external irradiation(30Gy) and brachytherapy(60Gy), while it was 1.7% in patients treated with brachtherapy alone(70Gy).

Brachytherapy is a fairly good therapeutic technique for the majority of the patients with tongue cancers. The multicombined treatment modality could provide the chance for cure of advanced lesions.

Key Words

Radiation therapy Carcinoma of the tongue 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Bartelink, H., Breur, K. and Hart, G.: Radiotherapy of lymph node metastasis in patients with squamous cell carcinoma of the head and neck region.Int. J. Radiat. Oncol. Biol. Phys. 8: 983–989, 1982PubMedGoogle Scholar
  2. 2).
    Crook, J. et al., Combined external irradiation and interstitial implantation for T1 and T2 epidermoid carcinomas of base of tongue.Int. J. Radiat. Oncol. Biol. Phys. 15: 105–114, 1988PubMedGoogle Scholar
  3. 3).
    Decroix, Y. and Ghossein, N.A.: Experience of the Curie Institute in treatment of cancer of the mobile tongue. I. Treatment policies and result.Cancer 47: 496–502, 1981PubMedGoogle Scholar
  4. 4).
    Decroix, Y. and Ghossein, N.A.: Experience of the curie Institute in treatment of cancer of the mobile tongue. II. Management of the Neck nodes.Cancer 47: 503–508, 1981PubMedGoogle Scholar
  5. 5).
    Ellis, E.R., Mendenhall, W.M., Parsons, J.T., Spangler, A.E. and Million, R.R.: Does node location affect the incidence of distant metastases in head and neck squamous cell carcinoma?Int. J. Radiat. Oncol. Biol. Phys. 17: 293–297, 1989PubMedGoogle Scholar
  6. 6).
    Epstein, J.B., Wong, F.L.W. and Stevenson-Moore, P.: Osteoradionecrosis: Clinical experience and a proposal for classification.J. Oral Maxillofac. Surg. 45: 104–110, 1987PubMedGoogle Scholar
  7. 7).
    Fuchihata, H.: Diagnosis and treatment of oral cancers.J.I.C.D. 21: 108–117, 1990Google Scholar
  8. 8).
    Horjuchi, J., Okuyama, T., Shibuya, H. and Takeda, M.: Results of brachytherapy for cancer of the tongue with special emphasis on local prognosis.Int. J. Radiat. Oncol. Biol. Phys. 8: 829–835, 1982Google Scholar
  9. 9).
    Housset, M., Baillet, F., Dessard-Diana, B., Martin, D. and Miglianico, L.: A retrospective study of three treatment techniques for T1-T2 base of tongue lesions: surgery plus postoperative radiation, external radiation plus interstitial implantation and external radiation alone?Int. J. Radiat. Oncol. Biol. Phys. 13: 511–516, 1987PubMedGoogle Scholar
  10. 10).
    Koch, C. J., Stobbe, C.C. and Hettiaratchi, P.: Combined radiation protective and radiation sensitizing agents. IV: Measurement of intracellular protector concentrations.Int. J. Radiat. Onocol. Biol. Phys. 16: 1025–1027, 1989Google Scholar
  11. 11).
    Kondo, M. et al., Local control of squamous cell carcinoma of the mobile tongue: An experience of different modalities.Int. J. Radiat. Oncol. Biol. Phys. 12: 755–760, 1986PubMedGoogle Scholar
  12. 12).
    Lusinchi, A., Bourhis, J., Wibault, P., Ridant, A.M. and Eschwege, F.: Radiation therapy for head and neck cancers in the elderly.Int. J. Radiat. Oncol. Biol. Phys. 18: 819–823, 1990PubMedGoogle Scholar
  13. 13).
    Maciejewski, B., Withers, H.R., Taylor, J.M.G. and Hliniak, A.: Dose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx. Part 2. Normal tissue response: Acute and late effects.Int. J. Radiat. Oncol. Biol. Phys. 18: 101–111, 1990PubMedGoogle Scholar
  14. 14).
    Marcus, R.B. and Million, R.R.: The incidence of myelitis after irradiation of the cervical spinal cord.Int. J. Radiat. Oncol. Biol. Phys. 19: 3–8, 1990PubMedGoogle Scholar
  15. 15).
    Marinello, G., Valero, M., leung, S. and Pierquin, B.: Comparative dosimetry between Iridium wires and seed ribbons.Int. J. Radiat. Oncol. Biol. Phys. 11: 1733–1739, 1985PubMedGoogle Scholar
  16. 16).
    Marx, R.E. and Johnson, R.P.: Studies in the radiobiology of osteoradionecrosis and their clinical significance.Oral Surg. 64: 379–390, 1987PubMedGoogle Scholar
  17. 17).
    Masaki, N. et al., Results of interstitial radiation therapy with Iridium-192 for patients with carcinoma of the oral tongue.Oral Radiol. 4: 125–131, 1988Google Scholar
  18. 18).
    Mazeron, J.J., Crook, J.M., Marinello, G., Walop, W. and Pierqui, B.: prognostic factors of local outcome for T1, T2 carcinomas of oral tongue treated by Irdium 192 implantation.Int. J. Radiat. Oncol. Biol. Phys. 19: 281–285, 1990PubMedGoogle Scholar
  19. 19).
    McGregor, G.I., Davis, N. and Edward Robins, R.: Squamous cell carcinoma of the tongue and lower oral cavity in patients under 40 years of age,Am. J. Surg. 146: 88–92, 1983CrossRefPubMedGoogle Scholar
  20. 20).
    Mendenhall, W.M., Cise, W.S., Bova, F.J. and Million, R.R.: Analysis of time-dose factors in squamous cell carcinoma of the oral tongue and floor of mouth treated with radiation therapy alone.Int. J. Radiat. Oncol. Biol. Phys. 7: 1005–1011, 1981PubMedGoogle Scholar
  21. 21).
    Mendenhall, W.M., Parsons, J.T., Amdur, R.J., Spangler, A.E., Williams, T.R., Cassisi, N.J. and Million, R.R.: Squamous cell carcinoma of the head and neck treated with radiation therapy: The impact of neck stage on local control.Int. J. Radiat. Oncol. Biol. Phys. 14: 249–252, 1988PubMedGoogle Scholar
  22. 22).
    Morrish, R.B., Chan, E., Silverman, S., Meyer, J., Fu, K.K. and Greenspan, D.: Osteonecrosis in patients irradiated for head and neck carcinoma.Cancer 47: 1980–1983, 1981PubMedGoogle Scholar
  23. 23).
    Moulder, J.E. and Fish, B.L.: Late toxicity of total body irradiation with bone marrow transplantation in a rat model.Int. J. Radiat. Oncol. Biol. Phys. 16: 1501–1509, 1989PubMedGoogle Scholar
  24. 24).
    Murray, C.G., Herson, J., Daly, T.E. and Zimmerman, S.: Radiation necrosis of the mandible: A 10 year study. Part I. Factors influencing the onset of necrosis.Int. J. Radiat. Oncol. Biol. Phys. 6: 543–548, 1980PubMedGoogle Scholar
  25. 25).
    Murthy, A.K., Taylor, S.G., Showel, J., Caldarelli, D. D., Hutchinson, J.C., Holinger, L.D., Witt, T.R. and Hoover, S.: Treatment of advanced head and neck cancer with concomitant radiation and chemotherapy. Int.J. Radiat. Oncol. Biol. Phys. 13: 1807–1813, 1987Google Scholar
  26. 26).
    Nakamura, M. et al., A histological grading of malignancy of squamous cell carcinoma of the tongue.Oral Radiol. 4: 7–13, 1988Google Scholar
  27. 27).
    Newman, A.N., Rice, D.H., Ossoff, R.H. and Sisson, G.A.: Carcinoma of the tongue in persons younger than 30 years of age.Arch. Otolaryngol. 109: 302–304, 1983PubMedGoogle Scholar
  28. 28).
    Parsons, J.T., Million, R.R. and Cassisi, N.J.: The influence of excisional or incisional biopsy of metastatic neck nodes on the management of head and neck cancer.Int. J. Radiat. Oncol. Biol. Phys. 11: 1447–1454, 1985PubMedGoogle Scholar
  29. 29).
    Pierquin, B.: The density of brachytherapy in oncology.Am. J. Roentgenol. 127: 495–499, 1976Google Scholar
  30. 30).
    Puthawala, A.A., Syed, A.M.N., Neblett, D. and McNamara, C.: The role of afterloading Iridium implant in the management of carcinoma of the tongue.Int. J. Radiat. Oncol. Biol. Phys. 7: 407–412, 1981PubMedGoogle Scholar
  31. 31).
    Rollo, J. et al.: Squamous carcinoma of the base of the tongue: A clinicopathologic study of 81 cases.Cancer 47: 333–342, 1981PubMedGoogle Scholar
  32. 32).
    Ruifrok, A.C.C., Levendag, P.C., Lakeman, R.F., Deuloo, I.K.K. and Visser, A.G.: Dose-effect relation of interstitial Low-Dose-Rate radiation in an animal tumor model.Int. J. Radiat. Oncol. Biol. Phys. 18: 31–36, 1990PubMedGoogle Scholar
  33. 33).
    Schmidt, W. and Popham, R.E.: The role of drinking and smoking in mortality from cancer and other causes in male alcoholics.Cancer 47: 1031–1041, 1981PubMedGoogle Scholar
  34. 34).
    Taylor, S.G.: Integration of chemotherapy into the combined modality therapy of head and neck squamous cancer.Int. J. Radiat. Oncol. Biol, Phys. 13: 779–783, 1987Google Scholar
  35. 35).
    Wang, C.C.: Radiotherapeutic management and results of T1NO, T2NO carcinoma of the oral tongue: Evaluation of boost techniques.Int. J. Radial. Oncol. Biol. Phys. 17: 287–291, 1989Google Scholar
  36. 36).
    Wang, C.C., Doppke, K.P. and Biggs, P.J.: Intra-oral cone radiation therapy for selected carcinomas of the oral cavity.Int. J. Radiat. Oncol. Biol. Phys. 9: 1185–1189, 1983PubMedGoogle Scholar
  37. 37).
    Wendt, C.D. et al.: Primary radiotherapy in the treatment of stage I and II oral tongue cancers: Importance of the proportion of therapy delivered with interstitial therapy.Int. J. Radiat. Oncol. Biol. Phys. 18: 1287–1292, 1990PubMedGoogle Scholar
  38. 38).
    Yamamoto, E., Kohama, G.I., Sunakawa, H., Iwai, M. and Hiratsuka, H.: Mode of invasion, Bleomycin sensitivity and clinical course in squamous cell carcinoma of the oral cavity.Cancer 51: 2175–2180, 1983PubMedGoogle Scholar

Copyright information

© The Japanese Society of Dental Radiology 1992

Authors and Affiliations

  • Kwang Joon Koh
    • 1
    • 2
  • Hiroshi Ikeda
    • 3
  • Kimishige Shimizutani
    • 3
  • Toshihiko Inoue
    • 3
  • Souhei Furukawa
    • 4
  • Kazuko Kubo
    • 4
  • Hajime Fuchihata
    • 4
  1. 1.Department of Oral & Maxillofacial Radiology, College of DentistryChonBuk National UniversityChon-JuKorea
  2. 2.Faculty of DentistryOsaka UniversityOsakaJapan
  3. 3.Department of RadiologyOsaka University HospitalOsakaJapan
  4. 4.Department of Oral & Maxillofacial RadiologyOsaka University, Faculty of DentistryOsakaJapan

Personalised recommendations