Swallowing and Speaking Evaluation After Resection and Reconstruction Versus Definite Radiochemotherapy for (Sub)total Tongue Cancer.

Abstract

Background: In very advanced tongue cancer, definite radiochemotherapy (RCHT) is often preferred over total or near total glossectomy due to organ preservation and functionality, particularly swallowing.

Methods: This retrospective study compares the functionality and survival of 10 patients with very advanced tongue cancer who received (sub)total glossectomy with prior or adjuvant RCHT and reconstruction by a musculocutaneous anterolateral thigh flap. All 10 patients had comparable tongue carcinomas treated by definite RCHT. Airway protection and swallow efficiency were evaluated by fiberoptic endoscopic evaluation of swallowing and graded using the Rosenbek Penetration and Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRS).

Results: Of 10 surgical patients, 7 were completely oralized after a mean of 17 days. For surgical patients, PAS scores swallowing saliva (mean 1.6 versus 2.9, P = 0.04) as well as vallecula (mean 4.0 versus 2.9, P = 0.05) and piriform sinus (mean 3.5 versus 2.5, P = 0.05) YPRS scores for saliva were significantly lower compared with definite RCHT. Irrespective of treatment, age older than 65 years (YPRS sinus piriformis H₂O 3.4 versus 2.5, P = 0.47), body mass index less than 20 kg/m² (PAS Jelly 4.7 versus 2.2, P = 0.015, YPRS sinus piriformis 4.0 versus 2.7, P = 0.028), and Karnovsky index less than 80 (PAS saliva 2.8 versus 1.6, P = 0.049) were associated with worse swallowing. Speech was intelligible in 80% of patients of both groups. Overall survival did not differ between the surgical group and definite RCHT.

Conclusions: Patients after (sub)total glossectomy with RCHT and adequate reconstruction with a musculocutaneous anterolateral thigh flap show equal or even better swallowing compared with patients after definite RCHT for advanced tongue cancer.