Tongue cancer after primary radiotherapy for nasopharyngeal carcinoma: Three cases report and literature review

Mnejja W, Siala W, Elloumi F, Daoud J, Fourati N


Purpose: Radiation induced cancer is a significant problem that can alter long term survival and quality of life after radiotherapy for nasopharyngeal carcinoma (NPC). Reports detailing radio induced tongue cancer are few. The aim of this study was to analyze clinicopathologic characteristics, treatment outcomes of radio induced tongue cancer developing after successful primary radiotherapy for NPC.

Patients and methods: Between 1993 and 2010, 507 patients with non metastatic NPC were treated by radical radiotherapy (70-75Gy) to the nasopharynx and involved lymph nodes with or without chemotherapy. Follow up was performed to evaluate tumor control and to detect late toxicity. We found 9 cases (1.7%) of second malignant tumor with no evidence of primary disease recurrence. Three of these patients (0.6%) had tongue localization.

Results: The age of patients at the time of primary radiotherapy was 24, 38 and 47 years. All patients had no history of cigarette smoking and alcohol drinking. The latency between radiotherapy for NPC and the diagnosis of tongue cancer was 36, 39 and 230 months. The three histopathology types were well- or moderately differentiated squamous cell carcinoma. The second tongue cancer occurred at the tongue base in two cases and the junction between the oral and the tongue base in one case. After undergoing treatment for second malignant tumor, one patient had no evidence of disease and two patients had never achieved complete response tumor and were alive with uncontrolled loco-regional disease.

Conclusion: Radio-induced tongue cancer is an uncommon complication of external beam radiotherapy for nasopharyngeal carcinoma. The risk may increase with a long term follow up and improved survival. The treatment of this second tumor is not well codified and the prognosis is poor comparatively with primary tongue cancer. Long term follow after treatment for NPC is necessary for early detection of this late complication.


Nasopharyngeal carcinoma; Tongue cancer; Radiation induced carcinoma

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Toumi N, Frikha M, Siala W, Khabir A, Karray H, Boudawara T, Gargouri RM, Ghorbel M, Daoud J. Les cancers du cavum juvéniles: aspects anatomocliniques, biologiques, thérapeutiques et évolutifs. Bulletin du Cancer 2010;97: 427-433.

Ho JHC. An epidemiologic and clinical study of nasopharyngealcarcinoma. Int J Radiat Oncol Biol Phys 1978;4: 183-198.

Shanmugaratnam K, Tye CY, Goh EH, Chia KB. Etiological Factors in Nasopharyngeal Carcinoma: a Hospital-based, Retrospective, Case-Control, Questionnaire Study. IARC Scientific Publication 1978;20:199-212.

Chen MC, Feng IJ, Lu CH, Chen CC, Lin JT, Huang SH, Lee KD. The incidence and risk of second primary cancersin patients with nasopharyngeal carcinoma:a population-based study in Taiwan over a 25-yearperiod (1979–2003). Ann Oncol 2008; 19:1180-1186.

Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 2004;22(22): 4604-12.

Malone JP and Levin RJ. Second malignant tumors after treatment of nasopharyngeal carcinoma :four case reports and literature review. Skull Base 2002; 2: 87-91.

Kochbati L, Boussen H, Gritli S. Secondary mandibular fibrosarcoma after chemoradiotherapy for undifferential nasopharyngeal carcinoma. Report of a case and review of the literature. Cancer Radiother 2001;5: 283-286.

Qian TN, Huang YR, Gu XZ. Radiationinduced cancer. Radiat Oncol Biol Phys 1983;9: 1246.

Daoud J, Siala W, Mnejja W, Elloumi F, Mnif J, Ghorbel A, Frikha M. Late toxicities after conventional radiotherapy for nasopharyngeal carcinoma: incidence and risk factors. Radiother Oncol 2011;98: S39-S40.

McDowell JD. An overview of epidemiology and common risk factors for oral squamous cell carcinoma. Otolaryngol Clin North Am 2006;39: 277-294.

Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation tooral and pharyngeal cancer. Cancer Res 1988;48: 3282-3287.

Teo PML, Chan ATC, Leung SF, Chau RMC, Yu PKW, Kingand WWK, Johnson PJ. Increased Incidence of Tongue Cancer after Primary Radiotherapy for Nasopharyngeal Carcinoma the Possibility of Radiation Carcinogenesis. Eur J Cancer 1999;35: 219-225.

Cooper JS, Scott C, Marcial V et al. The relationship of nasopharyngeal carcinomas and second independent malignancies based on Radiation Therapy Oncology Group Experience. Cancer 1991;67: 1673-1677.

Bensadoun RJ, Eschwège F, Schaab G, Wibault P. Late complications and sequelae of radiotherapy of adult’s

nasopharyngeal carcinomas. A study of 79 patients in Gustave-

Roussy Institute . Bull Cancer Radiother 1991; 78:149-64.

Cosset JM. Cancers radio induits: Le point en 1997. Cancer Radioth 1997;1: 823-35.

Cahan WG, Woodard HQ, Higinbotham NL, Steward FW, Coley BL. Sarcoma arising in irradiated bone report of eleven cases. Cancer 1948;5: 3-29.

Laskin WB, Silverman TA, Enzinger FM. Postradiation soft tissue sarcomas an analysis of 53 cases. Cancer 1988;62: 2330-2340.

Sun CZ, Chen FJ, Zeng ZY, Chen WK, Chen YF. Second

primary tumor of tongue after nasopharynx carcinoma

radiotherapy: report of 53 cases. Zhonghua Er Bi Yan Hou TouJing Wai KeZaZhi. 2005;40(11): 819-823.

Sun CZ, Chen FJ, Zeng ZY, Li QL, Chen YF, Song M. Comparison of primary tongue carcinoma with second primary tongue carcinoma after radiotherapy for nasopharynx cancer. ZhonghuaZhong Liu ZaZhi 2006; 28(12): 938-941.

Mian X, Liu MZ, Wang HX, Cai L, Zhang L, Xie CF, Li QQ. Radiation-induced sarcoma in patients with nasopharyngeal carcinoma. Cancer 2010: 5479-5486.



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