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