Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.Đánh giá kết quả điều trị ung thư lưỡi giai đoạn T1-2N1M0 bằng phẫu thuật kết hợp hóa xạ trị đồng thời.
MINISTRY OF EDUCATION MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DINH XUAN CUONG RESEARCH THE RESULTS OF TREATMENT OF T1-2N1M0 STAGE TONGUE CANCER BY SURGERY COMBINED WITH CONCURRENT CHEMORADIOTHERAPY Specialty : Oncology Code 9720108 SUMMARY OF DOCTORAL DISSERTATION HANOI - 2022 THE STUDY IS COMPLETED AT HANOI MEDICAL UNIVERSITY Supervisors: Prof.PhD Le Van Quang PhD.Dr Nguyen Phi Hung Critic 1: Associate Prof Pham Cam Phương, PhD Critic 2: PhD.Dr Bui Vinh Quang Critic 3: Associate Prof Le Ngoc Ha, PhD The thesis will be defended before the Examining Board at university level in Hanoi Medical University At time on month date 2022 The thesis can be found at - National Library of Vietnam - Library of Hanoi Medical University LIST OF PUBLICATION RELATED TO THE THESIS Dinh Xuan Cuong, Le Van Quang Survival results of T12N1M0 stage tongue cancer by surgery combined with concurrent chemoradiotherapy, Journal of Medical Research, no in 2021, 1-11 Dinh Xuan Cuong, Ma Chinh Lam, Le Van Quang Evaluation of lymph node metastasis of T1-2N0M0 stage anterior tongue cancer at K hospital, Journal of Otolaryngology, no 6, 2020, 556-561 Dinh Xuan Cuong Results of treatment of tongue cancer stage T1-2N0-1M0 with surgery combined with concurrent chemoradiotherapy at K hospital, Vietnamese Journa of Oncology, no 1, 2020, 69-73 INTRODUCTION Reason to choose the thesis Tongue cancer is the most common cancer in the oral cavity, accounting for 30-40% According to GLOBOCAN 2020, it is estimated that there are about 377,713 new cases of oral cancer worldwide and about 177,757 deaths every year According to records in Vietnam in 2020, there are about 2152 new cases of oral cancer and 1099 deaths every year Treatment strategy for tongue cancer include surgery, radiation and chemotherapy, in which the treatment regimen depends on the stage of the disease and the patient's condition For early-stage tongue cancer, surgery alone or in combination with adjuvant therapy after surgery has good results Many studies around the world showed that the combination of adjuvant treatment after surgery for early-stage tongue cancer reduces the risk of local recurrence, prolongs diseasefree survival and overall survival The study of Yu et al comparing the group of patients receiving adjuvant radiotherapy after surgery with the group of surgery alone showed that the adjuvant radiation group had a longer survival time A multicenter study evaluating the role of adjuvant chemoradiotherapy for head and neck squamous cell carcinoma found that chemoradiotherapy was effective in reducing local recurrence (RR = 0.59, p < 0.0001) and improved survival (RR = 0.8, p = 0.0002) In Vietnam, the adjuvant treatment after surgery for early-stage tongue cancer depends on the characteristics of tumor lesions in surgery and histopathological results However, currently, there are no studies on tongue cancer in T1-2N1M0 stage in Vietnam to provide clinical and subclinical characteristics as well as analyze risk factors to guide treatment methods after surgery Therefore, we conduct the study on the topic: "Research the results of treatment of T1-2N1M0 tongue cancer by surgery combined with concurrent chemoradiotherapy" to aim at achieving two objectives: Evaluation of the treatment results of T1-2N1M0 stage of tongue cancer by surgery combined with concurrent chemoradiotherapy Analysis of some clinical and histopathological prognostic factors Contributions of the thesis: Surgery combined with concurrent chemoradiotherapy is an effective treatment method for T1-2N1M0 stage tongue cancer The mean disease-free survival time was 45.3±2.3 months, the 5-year disease-free survival rate was 66.8% The mean overall survival time was 46.9±2.1 months, the 5-year overall survival rate reached 73.9% The recurrence rate is 25.7%, of which the majority of recurrences are in the cervical nodes (63.2%) Common chemical toxicity was vomiting and nausea accounted for 75.7%, in which grade III toxicity only encountered 9.7% The rate of leukopenia accounted for 66.2%, no grade IV toxicity was recorded Liver and kidney toxicity are rare Radiation toxicity is common in dermatitis and mucositis, mainly grade II (dermatitis 58.1%; mucositis 60.8%) Most patients had xerostomia complications (90.5%); in which grade is the most common (36.5%) Skin fibrosis occurs 48.6%; mainly grade I (32.4%), cleft palate 16.2%, mostly grade I (10.8%) There is a correlation between the recurrence rate and histological grade, depth of invasion and lymph node rupture status There was a correlation between disease-free survival, 5-year overall survival and factors of histological grade, depth of invasion and ruptured lymph node Structure of the thesis: The thesis consists of 116 pages, with main chapters: Introduction pages, Chapter (Literature review) 29 pages, Chapter (Study subjects and methodology) 16 pages, Chapter (Findings) 31 pages, Chapter (Discussion) 35 pages, Conclusions and Recommendations pages The thesis includes 42 tables, figures and 17 charts, 117 references (22 Vietnamese documents, 95 English documents) Chapter 1: OVERVIEW Combination treatment of surgery and concurrent chemoradiotherapy for early stage tongue cancer 1.1.1 Surgery 1.1.1.1 Primary tumor - T1: wide tumor resection, margin > cm from the edge of the tumor, if possible, immediate biopsy of resection margin - T2: Partial tongue resection and cervical lymphadenectomy 1.1.1.2 Regional lymph node * Indication: - For lymph nodes that are not clinically palpable: only selective lymphadenectomy is enough (group I, II, III lymph node dissection because the rate of metastasis is common in groups I and II) 1.1 - For clinically palpable lymph nodes: + Lymph node size ≤ cm, functional cervical lymphadenectomy + Lymph node size is > cm, radical cervical lymphadenectomy + Fixed lymph nodes, attached to surrounding tissue, chemotherapy or radiotherapy first, consider surgery later 1.1.2 Concurrent chemoradiotherapy - Radiotherapy * Indication: Postoperative adjuvant radiation therapy, with or without concurrent chemotherapy, is indicated for patients with positive or asymptotic resection margin, bone invasion, or lymph node metastasis on postoperative pathology Postoperative radiotherapy should be considered if there is lymphatic or neurological invasion of the primary tumor * Technique and indications for radiotherapy Postoperative radiotherapy Tumor: + With negative resection margin, radiation dose is 50 Gy at 1,8 – Gy/fraction + With positive resection margin, radiation dose is 70 Gy at 1,8 – Gy/fraction Lympho nodes: + Total neck lymph node radiotherapy with dose at 45 – 55 Gy + Ruptured lymph node: increase the dose from 10 – 15 Gy - Chemotherapy Use symtemic or oral agents, can be used alone or in combination with multiple chemicals Studies have shown that multiple chemotherapy regimens results in better response than monotherapy Through many clinical trials, cisplatin-containing regimens increased survival rates in the treated group After cervical lymphadenectomy, if metastases on lymph nodes or metastases break the envelope, chemotherapy is also indicated in combination with postoperative radiotherapy The chemical used is Cisplatin with a dose of 100mg/m2 of skin alternately on the 1st, 15th and 30th day of radiation treatment There are many different regimens applied to head and neck cancer, in which CF regimen is cheap, good response results but low toxicity 1.1.3 Radiotherapy combined with chemotherapy regimens with platinum group At least three clinical trials have demonstrated the benefit of improving overall or disease-free survival with a combination of platinum-based chemotherapy and radiation compared with radiation alone + The EORTC study included 334 high-risk squamous cell carcinoma patients of the oral cavity, oropharynx, larynx, and hypopharynx Intervention group: radiation combined with chemotherapy (cisplatin 100 mg/m2, IV days 1, 22, 43 of radiation) compared with the radiotherapy alone group with the same dose (66 Gy, Gy/day) At the 60-month follow-up, concurrent chemoradiotherapy had a higher 5-year disease-free survival (47% vs 36%), a higher overall survival (53% vs 23%) However, grade 3, adverse events on mucosa were higher in the combination treatment group (41% vs 21%) + The RTOG study included 459 patients with high-risk squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: radiotherapy group with doses of 60-66 Gy in 30-33 fractions, combined with cisplatin days 1, 22, and 43 of radiation compared with the radiotherapy alone group with the same dose At the 46-month follow-up, the intervention group had a higher 4-year disease-free survival (40% vs 30%) and a lower local recurrence rate (19% vs 30%) However, the difference in overall survival was not statistically significant and grade and adverse events were higher in the combination treatment group 1.2 Several studies of T1-2N1M0 stage tongue cancer Many research around the world, such as the studies of Yu, Shrime, Tsai, Vanessa demonstrated that adjuvant radiotherapy improves 5-year disease-free survival time and overall survival compared with surgery alone for early-stage tongue cancer Some other studies such as the study of EORTC, RTOG, Cooper recorded better local control rate, improved survival of concurrent chemoradiotherapy compared with radiation alone Histological grade, tumor depth are factors related to the outcome of control and survival In Vietnam, surgery combined with adjuvant chemoradiotherapy is also used to treat patients with early-stage tongue cancer with highrisk factors A study by Vu Viet Anh (2014) evaluated 47 patients with T1-2N0-1 stage tongue cancer who were treated surgically and then combined with radiotherapy alone or chemoradiotherapy at Vietnam National Cancer hospital, the average survival time overall is 43 months The survival time with the radiation group alone was 42.1 months (74%), and the concurrent chemoradiation group was 43.7 months (82.9%) - - Chapter 2: OBJECTIVES AND METHODOLOGY 2.1 Research subjects Research subjects consist of 74 patients with pT1-2N1M0 stage tongue cancer that has met the following selection criteria and exclusion criteria: Selection criteria The patient was diagnosed with anterior tongue cancer by histopathology as squamous cell carcinoma The stage of disease after surgery is: T1-2N1M0 in accordance with AJCC 2010 Performance status (PS): 0-1 Good bone marrow function, good liver and kidney function: + White blood cells ≥ G/l + Hemoglobin ≥ 125 g/l + Platelets ≥ 150 G/l + AST/ALT ≤ 40 U/l + Creatinine ≤ 100 mmol/l No serious acute and chronic diseases at risk of death, no cancer other Indication for postoperative concurrent chemoradiotherapy Have full archival records and have contact information of the patients after treatment Exclusion criteria Have a history of other cancer The patient did not receive adjuvant chemoradiotherapy The planned radiotherapy is not fully performed Patients > 70 years old 2.2 Time and place of the study - Time of the study: from September 2015 to July 2021 - Place of the study: K Hospital 2.3 Study methodology 2.3.1 Design of the study - Study methodology: Clinical intervention without control group Calculation of the sample size p(1 – p) n = Z21-α/2 d2 Where: n : Minimum sample size in the study Z1−α / - : confidence coefficient with a probability level of 95% (α = 0,05)→Z = 1,96 p: overall survival rate at the year period of T1-2N0-1 stage tongue cancer (p = 0.808) (Shim SJ- 2010) d: deviation of p, select d = 0.1 Minimum sample size is 59 patients Sampling is from 74 patients 2.3.2 Research variables Age: divided into age groups: 40, 41 -50, 51 – 60, > 60 Gender: Male, female Performance status index: calculated according to the scale of the Eastern Cooperation Oncology Group (ECOG: Eastern Cooperation Oncology Group) Time from symptom onset to treatment: in months Some risk factors: drinking alcohol, smoking, oral disease Clinical symptoms Subclinical symptoms: histopathology, imaging Diagnosis of staging according to AJCC 2010 Surgical results: postoperative time, postoperative complications Chemoradiotherapy outcomes Survival time: disease-free survival time, overall survival time The relationship between survival time and factors: age, sex, stage of disease, histological grade, depth of invasion Side effects of the regimen + On the hematological system: leukopenia, thrombocytopenia, anemia + Extra-hematological system: increased liver enzymes, increased urea, increased creatinine + Adverse effects of radiation therapy: dermatitis, skin fibrosis, jaw tightening - • • - Some clinical and histopathological prognostic factors: age, gender, histological grade, deep invasion, tumor stage T1/T2 2.3.3 Conducting method 2.3.3.1 Collecting information about patient characteristics 2.3.3.2 Surgery 2.3.3.3 Adjuvant chemoradiotherapy The patient received concurrent chemoradiotherapy with the Cisplatin regimen every weeks Conducted to weeks after surgery Chemical composition Cisplatin 100mg/m2, IV, day 1, day 22, day 43 Radiotherapy techniques: + Implementation steps Treatment simulation: patient immobilization, computed tomography simulation Treatment planning: determination target volume according to ICRU 50 and IRCU 62 recommendations, indicate radiation doses + Monitoring and responding during radiotherapy 2.3.3.4 Follow up after treatment After the end of treatment, patients were followed up every months for the first years, every months for the next years and once a year for the following years 2.4 Data analysis: - Information on patients participating in the study is collected according to the pre-established research sample records - Using IT software SPSS 22.0 to analyze statistics: - Descriptive statistics: Average, standard deviation - Rate comparison: Test χ2 (p < 0.05) or Fisher's exact test - Kaplan - Meier survival rate estimation method CHAPTER 3: RESULTS After doing a study on 74 patients from 2015 to 2021, we had some following conclusions: 3.1 Some clinical and histopathological characteristics of studies patient group 3.1.1 Age and gender - Age: average age was 53.4 ± 8.2, max was 68 years old and was 34 years old - Gender: male / female was 44/30 = 1.47 3.1.2 Medical history and symptoms - Medical history: a large number of patients had risk factors 3.3 Survival analysis 3.3.1 Disease-free survival Disease-free survival Chart 3.1: Graph of disease-free survival During follow-up, there were 19 patients presented with recurrent/metastatic status 5-year DFS rate was 72.1%, mean DFS was 45.3±2.3 months Relation between disease-free survival and risk factors Chart 3.2 Disease-free survival and age 5-year DFS rate with age ≤60 and >60 tuổi were 69.1% and 69.3%, respectively There was no significant difference between these groups, p=0.724 Chart 3.3: Disease-free survival and gender 5-year DFS rate with gender male and female were 49.4% and 54.4%, respectively There was no significant difference between these groups with p=0.176 Chart 3.4: Disease-free survival and tumoral stages There was no significant difference for 5-year DFS rates with tumoral stage T1 and T2, p = 0.320 Chart 3.5: Disease-free survival and tumoral grades 5-year DFS rates with grades I, I and grade III were 71.4% and 34.6%, respectively There was significant difference between these groups with p = 0.003 Chart 3.6: Disease-free survival and depth of invasion Group of patients with DOI > 5mm had lower 5-year DFS rate than group of patients with DOI ≤ 5mm (47.0% vs 84.8%, respectively) There was significant difference between these groups with p=0.002 Chart 3.7: Disease-free survival and extranodal extension Group of patients with EXE + had lower 5-year DFS rate than group of patients with EXE - (22.7% vs 76.6%, respectively) There was statistically significant difference between these groups p=0.0001 3.3.2 Overall survival Overall survival Chart 3.8: Overall survival During average follow-up time of 35.3 ± 12.1 months (16 – 62 montsh), there was 17 death events 5-year OS rate was 73.9%, mean OS was 46.9±2.1 months Relation between overall survival and risk factors Chart 3.9: Overall survival and age 5-year OS rate with age ≤ 60 was 78.3% compared with patients aged > 60 (68.8%), there was no significant difference between these groups with p=0.681 Chart 3.10: Overall survival and gender There was no significant difference for overall survival between male and female patients (56.4% vs 74.8%, respectively), there was no significant difference between these groups with p=0.112 Chart 3.11: Overall survival and tumoral stage There was no significant difference for 5-year OS rates with stage T1 and T2, p = 0.206 Chart 3.12: Overall survival and tumoral grades Patients with grades I, II had higher 5-year OS rates than patients with grade, accounting for 78.7% and 31.4%, respectively There was significant difference between these groups with p=0.012 Chart 3.13: Overall survival and depth of invasion 5-year OS rates with DOI > 5mm and DOI ≤ 5mm were 87.4% and 47.1% there was significant difference between these groups with p=0.002 Chart 3.14: Overall survival and extranodal extension 5-year OS rates of patients with ENE + and ENE – were 78.9% and 27.3%, respectively There was significant difference between these groups with p=0.0004 3.3.3 Adverse events 3.3.3.1 Adverse events on hematology Table 3.3 Adverse events on hematology All Grade Grade Grade Grade I grades II III IV Adverse events n % n % n % n % n % Leukopenia 49 66,2 20 27 22 29,7 9,4 0 Neutropenia Thrombocytopenia Anemia 43 58,1 28 36 9,5 8,1 0 0 0 27 36,5 25 33,8 2,8 0 0 8,1 9,5 1,4 For adverse events on hematology, leukopenia was the most common, accounting for 66.2%; grade-III leukopenia occured in 9.4% of cases There was no report of grade-IV leukopenia Neutropenia was seen in more than 50% cases, but there was one patient presented with grade-IV adverse events Low hemoglobin occured less often than other toxicities, accounting for 36.5%, no report of grades III and IV Thrombocytopenia was not often seen in our study, accounting for 8.1% cases, only grade-I 3.3.3.2 Adverse events on liver, kidneys and other organs Table 3.4 Adverse events on liver, kidneys All Grade Grade Grade Grade I Adverse grades II III IV events n % n % n % n % n % Elevated liver 9,4 7,8 1,6 0 0 enzymes Elevated ure 1,6 1,6 0 0 0 Elevated 6,7 5,4 1,6 0 0 creatinine Toxicity on liver and kidneys was not often seen in our study, elevated liver enzymes accounted 9.4%, elevated ure accounted for 1.6% and elevated creatinine accounted for 6.7% There was no patients with grade-III and -IV adverse events Adverse events Table 3.5 Other toxicities All Grade I Grade II grades n % n % n % Grade III n % Grade IV n % Vomitting, 56 75,7 18 24,3 31 41,9 9,4 0 nausea Anorexia 37 50 36 48,6 1.4 0 0 Peripheral 8,1 6,8 1,4 0 0 nerve Dermatologic 74 100 18 24,3 43 58,1 13 17,6 0 toxicity Mucositis 74 100 11 14,9 45 60,8 18 24,3 0 Vomitting and nausea mainly occured, especially at grades I and II Grade III accounted for 9.4% 50% of patients presented with anorexia, only grades I and II Peripheral nerve toxicity occured in cases, accounted for 8.1% All of patients had dermatologic toxicities and mucositis after chemoradiation, mostly grade-II (dermatologic toxicities accounted for 58.1%; mucositis accounted for 60.8%) Table 3.6 Late toxicities after chemoradiation All Grade Grade Grade I Grade II grades III IV Toxicities n % n % n % n % n % Xerostomia 67 90,5 25 33,7 27 36,5 15 20,3 0 Skin fibrosis 36 48,6 24 32,4 12 16,2 0 0 Trismus 12 16,2 10,8 0,05 0 0 Most of patients presented with toxicities of mouth dry (accounting for 90.5%); most of these patients presented with grade-II xerostomia (accounting for 36.5%) Dermatologic fibrosis was seen in 48.6% cases; mostly grade-I (accounted for 32.4%) Trismus was reported in 16,2% cases, mostly grade-I (accounted for 10.8%) There was no patient with grade-IV late toxicities CHAPTER 4: DISCUSSION 4.1 Clinical and sub-clinical characteristics Age: in our study, 74.3% of patients were above 50 years olds, mean age was 53.4±8.2 Ngo Xuan Quy’s study, mean age was 54.1, Vu Viet Anh’s showed that 93.6% of patients were above 40 and mean age was 57.49, Shabbir Akhtar’s study, mean age was 55 A study of Sagheb (2016) showed that the average age was 59 Gender: male/female ratio has changed depended on the results of studies, Vu Viet Anh’s study was 1.76/1, Ngo Xuan Quy’s study was 1.3/1, Kiyoto Shiga’s study was 1.52/1, Shabbir Akhtar’s study was 1.6/1, Nguyen Quoc Bao’s was 1.2/1 In our study, male/female ratio was 1.47/1 Male patient rate was higher that of female, a possible reason was that men receive many negative effects from many risks causing tongue cancer such as smoking, drinking alcohol Medical history: smoking, drinking alcohol were risk factors caused the oral cavity cancer, especially tongue cancer In our study, smoking was accounted for 44.5% and drinking alcohol was accounted for 48.6% This was similar to the results of others studies in our country and in the world Time to diagnosis: average time to diagnosis was 6.1 ± 2.4 months Our result was similar to those of other authors in our country and in the world Clinical symptoms: Most of patients had tumor and ulcer in the tongue at the time of diagnosis Our result was similar to those of other authors, including Tran Dang Ngoc Linh’s study (47.6% vs 40.7%, respectively), Tran Van Cong’s study (28.1% vs 42.9%, respectively), Ngo Xuan Quy (46.2% vs 39.2%, respectively) Performance status: In our study, all of patients had performance status of ECOG 0-1 point, because the treatment protocol included surgery, followed by chemoradiation, was similar to the study design of clinical trials in the world Our study showed that most of patients had the performance status with ECOG point, accounting for 59.5% Systematic symptoms: most of patients in our study had weight loss lower than 5% (accounting for 66.2%), and 33.8% of patients had weight loss over 5% Tongue cancer can affect daily nutrition of patients, so that it could lead to weight loss Tumor stage: stage-T2 was the most common (65.5%), stage-T1 was accounted for 36.5% Ngo Xuan Quy’s study giai đoạn II chiểm 63,8%, Anna Lee giai đoạn I chiếm 52,1% Anatomopathology: In our study, squamous cell carcinoma grade-II was the most commom (accounted for 60.8%), followed by grade-I (accounted for 22.9%), and grade-III was reported in 16.8% Our result was similar to result of Ngo Xuan Quy’s study, the rate of grade I, grade II and grade III were 21.5%; 70% and 7.7%, respectively A study of Su Jung Shim, squamous cell carcinoma with high differentiation and medium-low differentiation rates were 61% and 39%, respectively; Tseng-Cheng Chen’s study showed that high differentiation was the most common type of cancer, accounted for 87.1% Depth of invation: one of risk factors related to high rate of cervical node metastais and poor prognosis for survival of patients with tongue cancer In our study, rate of patients with DOI > 5mm was 66.2% Our result was similar to those of other authors in the world Neck lymph node metastasis: In our study, among 74 patients with postoperative diagnosis, there was 40.5% of patients that did not present neck lymph node metastasis A study of Nguyen Duc Huan, rate of occult lymph node metastasis was 29.6% Ngo Xuan Quy’s study showed that there was 30.7% of tongue cancer patients presented with lymph node metastasis In our study, group-II metastasis was the most common, then group-I, and group-III metastasis was rare Our result was similar to those of other authors in our country and in the world 4.2 Treatment results 4.2.1 Recurrence characteristics During the follow-up, there were 19 patients presented with recurrent diseases (accounting for 25.7%), among these 19 patients, reccurent lymph node metastasis was the most common (accounting for 63.2%), then at tongue (accounting for 15.7%), and both tongue and cervical nodes were 10.5%, there were patients have distant metastasis (accounting for 10.5%) Our result was similar to those of other authors, including Ngo Xuan Quy (24.6%), Ikram M (36.4%), Chen T.C (27.1%) Relation between recurrence and risk factors Age, gender: In our study, there was a non-significant relation between recurent diseases and age, gender Our result was similar to those of authors Bo Wang, Anne Lee Tumor grades: High tumor grade patients have high risk of recurrence than low-middle grade patients (p < 0.05) Our result was similar to those of author Bo Wang DOI: Rate of recurrent disease in group of > 5mm was higher than those with DOI ≤ 5mm and there was a significant difference between two groups with p = 0.001 Our result was similar to those of other authors Tumor stage: In our study, tumor stage-T2 has higher risk of recurrence than stage-T1, but there was no significant difference 4.2.2 Overall survival and disease-free survival 5-year disease-free survival rate (DFS) was 72.1% and mean DFS was 45.3±2.3 months 5-year overall survial rate (OS) was 73.9% with mean OS of 46.9±2,.1 months Our result was similar to those of ohter authors: Nguyen Duc Loi (5-year OS: 62.7%), Vu Viet Anh (4-year OS: 80%), Ngo Xuan Quy (5-year OS: 65,4%), Su Jung Shim (5-year DFS: 74%, 5-year OS: 71%) Relation between survival time and risk factors Age: Our study showed that there was non-significant difference about survival time In the world, there were some studies showed differences results Studies of Ngo Xuan Quy, Richard J, Deniella showed that there was a significant difference about survival time between groups of ages, some studies showed non-significant differences, including studies of Su Jung Shim, Anna Lee Gender: Our study showed that there was non-significant difference about survival time between male/female genders Our result was similar to those of other authors in our country and in the world (Vu Viet Anh, Kiyoto Shiga, Jefferey C Liu) Tumor stage: Our result showed that there was no difference for survival between stage T1 and T2 Studies of Ngo Xuan Quy, Anna Lee, Daniella… showed that 5-year DFS and 5-year OS of stage-T1 were higher than those of stage-T2 (p < 0.05) In our study, all of patients diagnosed of stage III (pN1), and cervical node metastasis is one of strongly risk factors affected to survival time Tumor grade: There was a significant difference for survival between tumor grade-III vs grade-I, II (p < 0.05) Our result was similar to those of other authors, including Ngo Xuan Quy, Thomas Mucke, Su Jung Shim, Daniella DOI: There was a significant difference for survival between group of DOI > 5mm and of DOI ≤ 5mm (p < 0.05) Several studies showed that DOI is one of risk factors for tongue cancer, increases the risk of cervical node metastasis and affects survival rates (Su Jung Shim, Ahmed S.Q, Daniella) 4.2.3 Toxicities of treatment Toxicities on hematology Evaluating the toxicities on hematology system, among 74 patients treated: Leukopenia was one of the most common toxicities (accounted for 66.2%); grade-III leukopenia was reported in 9.4% of cases, there was no patients presented with grade-IV leukopenia Neutropenia was reported in more than 50% cases, but only one patient suffered from neutropenia grade-IV, and there was no complications in all of cases Anemia was reported less often than others, accounted for 36.5%, and no report of grade-III, IV Thrombocytopenia was rarely occured in our study, accounted for 8.1%, and only presenting of grade-I There.was no death or grade-V related to toxicities of our treatment When patients presented with these toxicities, it could be interruption between cycles chemotherapy or stopping both chemotherapy and radiotherapy, therefore several patients did not receive enough doses of chemotherapy and radiotherapy Compared to results of other previous studies, our result was similar to those of other authors Toxicites on non-hematology systems In our study, vomitting and nausea was reported in most of patients, and rate of grade-III vomitting was only 9.4% Our result was similar to those of other authors using chemotherapy of cisplatin every weeks This is one of particular characteristics of cisplatin-based regimen chemotherapy However, grade-I,II of vomiting and nausea in our study were the most common Anorexia was common in 50% of cases in our study This is also one of common adverse events, however it is difficult to assess and able to be affected by other factors, especially pschology One of toxicities was peripheral nerve toxicity related to cisplatinbased chemotherapy Our result was similar to those of other previous authors There were patients reported with peripheral nerve toxicities, accounted for 8.1%, and only presented with grade-I, II Local toxicities caused by radiotherapy - Dry mouth Dry mouth was one of the most common local toxicities in our study, accounted for 90.5%, including grade-I (accounting for 33.7%); grade-II (accounting for 36.5%) and grade-III (accounting for 20.3%), no report of grade-IV A meta-analysis of Petr Szturz et al in 2017 for studies reported with dry mouth caused by radiotherapy, average rate of grade 3-4 was 2% (95% CI : 1-6%) However, when they assessed the long-term dry mouth toxicity, average rate of grade -I,II dry mouth was 59%, and average rate of grade-III, IV was 10% - Mucositis 100% of patients suffered from mucositis, mostly grade-I,II, rate of grade-III was only 24.3%; and there was no report of grade-IV mucositis in our study A study of (2013) showed that rate of mucositis was 31.1% in group of chemoradiation and 19.6 in group of radiotherapy A study of (2012) reported that rate of mucositis in patients treated with chemoradiotherapy was 30%, and in patients treated with radiotherapy was 18% - Dermatologic toxicity caused by radiotherapy 100% of patients suffered from acute dermatology toxicities caused by radiotherapy, including grade-I (acounted for 24.3%) and grade-II (58.1%), no report of grade-IV A meta-analysis of Petr in 2017 showed that rate of drade-II, II acute dermatitis related to radiotherapy was 11% (95% CI : 7-16%) A study of adjuvant chemoradiation with weekly cisplatin for the treatment of head and neck cancer patients, neck skin fibrosis was reported in of 30 patients CONCLUSION Results for the treatment of tongue cancer staged T1-2N1M0 treated with surgery followed-by adjuvant chemoradiotherapy - Most of patients were received cycles of chemotherapy with fulldose combined with radiotherapy - Rate of recurrence was 25.7%, among these patients, cervical node recurrence was common (accounting for 63.2%) - Mean disease-free survival was 45.3±2.3 months, 5-year DFS rate was 66.8% - Mean overall survival was 46.9±2.1 months, 5-year OS rate was 73.9% - Common chemotherapy toxicites were vomitting and nausea (accounting for 75.7%), including grade-III (accounting for 9.7%) Rate of leukopenia was 66.2%, there was no report of grade-IV Toxicities on liver and kidneys were less common - Common radiotherapy toxicities were dermatitis and mucositis, mostly grade-II (dermatitis accounted for 58.1%; mucositis accounted for 60.8%) Most of patients suffered from dry mouth (accounted for 90.5%), and grade-II was the most common (accounting for 36.5%) Skin fibrois was report in 48.6%; mostly grade-I (accounting for 32.4%), trismus accounted for 16.2%, mostly grade-I (accounting for 10.8%) Analysing the prognostic factors - For recurrence rates, there was statistically significant relation for factors of tumor grades, depth of invasion and extranodal extension There was a non-significant for ages, genders and tumor stage - For disease-free survival and overall survial rates, there was statistically significant relation for factors of tumor grades, depth of invasion and extranodal extension There was a non-significant for ages, genders and tumor stage SUGGESTIONS Surgery followed by adjuvant chemoradiotherapy was the efficacy treatment for tongue cancer staged T1-2N1M0 Longer follow-up time should be assessed to evaluate the longterm efficaces of protocol and prognostic factors for the treatment of tongue cancer staged T1-2N1M0 ... most common (65.5%), stage-T1 was accounted for 36.5% Ngo Xuan Quy’s study giai đoạn II chiểm 63,8%, Anna Lee giai đoạn I chiếm 52,1% Anatomopathology: In our study, squamous cell carcinoma grade-II... results of treatment of T1-2N1M0 tongue cancer by surgery combined with concurrent chemoradiotherapy" to aim at achieving two objectives: Evaluation of the treatment results of T1-2N1M0 stage of tongue... cancer staged T1-2N1M0 Longer follow-up time should be assessed to evaluate the longterm efficaces of protocol and prognostic factors for the treatment of tongue cancer staged T1-2N1M0