By modifying an existing technique of transplanting tissue from a patient's forearm to his tongue, surgeons can provide enough bulk to help improve the vital process of swallowing. The modification involves including a 'jellyroll'of fat and connective tissue along with the tissue and skin of the forearm to replace the diseased tongue tissue that is removed if a patient opts for surgical treatment of the cancer. The surgery is then followed up with radiation or chemotherapy, but that shrinks and scars the tongue, turning normally elastic and pliable tissue to something like wood. This reduces the patient's ability to swallow to the point that they must be fed through a tube placed through their skin directly into the stomach, because they can't take enough food to maintain their calorie requirements.
The so-called 'beavertail' modification adds more bulk to the tongue, helping protect it from the effects of radiotherapy.
The study's findings support the position that the surgery is just as effective as the standard treatment of combined chemotherapy and radiotherapy, but the surgical technique also preserves the patient's ability to swallow, said Dr. Dan O'Connell, lead author on the study and a surgical resident in the University of Alberta's Division of Otolarynology – Head and Neck Surgery.
"Other centres in Canada treat patients using radiotherapy and chemotherapy alone, and it was thought that the results were as good or better than what any surgery could do," O'Connell said. "But we found that by adding that jellyroll of tissue, you give the tongue ability to compensate for its lack of mobility." The technique, developed by Dr. Hadi Seikaly and Dr. Jeff Harris, preserves the patient's ability to swallow after treatment.
The study was conducted jointly by researchers in the University of Alberta faculties of Medicine and Dentistry, and Rehabilitation Medicine, as well as the Misericordia Hospital in Edmonton, Canada. O'Connell presented their findings at the international meeting of the annual American Head and Neck Society in Chicago earlier this year, where the study won the title of Best Resident Clinical Research Award.
The beavertail modification meant that 95 per cent of the 20 patients who completed the study (there were 36 originally) were able to swallow successfully after one year of tongue reconstruction. Only one patient still had problems with swallowing.
The surgery involves removing the cancerous tissue and replacing it with a healthy paddle of skin and connective tissue with artery intact, and connecting it to healthy blood vessels in the neck. The beavertail of fat that comes with the skin is connected to the base of the tongue to add bulk, and tolled upon itself, much like a jellyroll. The tongue is crucial to the swallowing process; the base of a healthy tongue acts as a piston that pushes food down the throat. With surgery, the reconstructed tongue instead acts as a buttress, which squeezes the food into the esophagus.
There are about 900 cases of cancer of the base of tongue or tonsils diagnosed in Canada each year, and while that accounts for just one per cent of all cancers in North America, doctors are seeing a disturbing trend. The cancer is attributed to smoking and alcohol consumption, but the fastest-growing group of new cases involves people who don't have those risk factors. "It's not an epidemic, but it is scary when you realize you can do everything right and still be saddled with this condition," O'Connell noted.
The research team hopes the study's findings will convince other doctors treating patients with base of tongue cancers that primary surgery followed by radiation gives them the best chance at swallowing after their treatment.
Bev Betkowski | EurekAlert!
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