Radical surgery with adjuvant therapy in advanced oral tongue cancer: Survival trends and functional outcomes.

Abstract

e18027 Background: Advanced oral tongue cancer (T3 or T4) is a challenging malignancy requiring aggressive multimodality treatment. This study retrospectively analyzed outcomes in patients treated with radical surgery followed by adjuvant therapy to evaluate survival and functional outcomes in this cohort. Methods: A retrospective cohort study was conducted on 159 patients with advanced oral tongue cancer (T3: n=92, T4: n=64) treated at our institute between January 2018 and January 2023. All patients underwent type IV or V glossectomy with neck dissection followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CTRT). Functional outcomes, including the Functional Oral Intake Scale (FIOS) and Dysphagia Severity Grade, were measured immediately post-surgery and at 6 months. Overall survival (OS) was analyzed using Kaplan-Meier estimates, stratified by nodal status (N0 vs. N+), and Cox regression was used to identify prognostic factors. Functional outcomes were compared using the Wilcoxon Signed Rank Test, Chi-Square tests, and Marginal Homogeneity Tests. Results: The cohort had a mean age of 49.2 years and a male predominance (93.7%). Tumor stage distribution was pT3 (57.9%) and pT4 (42.1%). Most tumors were moderately differentiated squamous cell carcinomas (58.5%), and 64.2% had nodal metastasis. The 3-year OS was 49.2%, with median survival for the overall cohort at 15.6 months (95% CI: 11.6 - 19.6). Nodal metastasis was associated with significantly reduced survival (median OS: 12.9 months for N+ vs. 22.0 months for N0, p=0.004). Functional outcomes showed significant improvement in FIOS scores (p<0.001) and Dysphagia Severity grades (p<0.001) over time. Patients receiving adjuvant therapy had better functional improvements compared to those who defaulted (p=0.04). Non improvements in FIOS did not correlate with death due to other causes. Patients without extracapsular extension (ENE) who received postoperative concurrent chemoradiotherapy did not show a significant decline in survival outcomes compared to those with metastatic nodes without ENE who received only adjuvant radiotherapy. Conclusions: Advanced oral tongue cancer treated with radical surgery and adjuvant therapy shows moderate survival outcomes, with nodal metastasis as a critical prognostic factor. Although significant functional impairments are observed immediately after surgery, many patients show considerable improvement over time; however, severe dysphagia persists in some cases even after one year. Alternative treatment approaches, such as neoadjuvant immunotherapy, should be explored for advanced operable tongue cancers to improve outcomes to reduce treatment related morbidity.