Management of T1N0 Tongue Carcinoma with Perineural Invasion

Primary Treatment Considerations

• Wide local excision (partial glossectomy) with adequate margins (≥5 mm when possible) is recommended for T1N0 tongue cancer with perineural invasion, as part of the initial surgical management 1
• For tongue tumors, ipsilateral selective neck dissection (levels I-IV) is appropriate for well-lateralized lesions 1

Adjuvant Radiation Therapy Protocol

• The total dose for adjuvant radiotherapy should be 56-60 Gy to the tumor bed and ipsilateral neck, using standard once-daily fractionation of 2 Gy per fraction 2
• Treatment should encompass the tumor bed and involved/at-risk lymph node regions 2
• For well-lateralized tongue tumors, unilateral radiotherapy may be considered 2

Surveillance Considerations

• TSH levels should be monitored every 6-12 months following adjuvant radiation, as hypothyroidism occurs in 20-25% of patients receiving neck irradiation, according to the National Comprehensive Cancer Network 3