Dr. M. A. Raja and Dr. Sivaram Ganesamoni explain how chemotherapy, extensive surgery, and reconstruction enabled disease control in a 41 year old patient
A 41 year old man with advanced tongue cancer, previously assessed as inoperable at multiple centres, has been treated successfully following a multi stage clinical approach at MGM Cancer Institute in Chennai. The case involved an aggressive squamous cell carcinoma with extensive spread across the anterior tongue, floor of the mouth, and extension up to the hyoid bone.
The patient, a known smoker, presented with a persistent ulcer and abnormal growth on the tongue. Clinical examination and biopsy confirmed squamous cell carcinoma, a common but potentially aggressive form of oral cancer. Further assessment using whole body PET imaging revealed deep vertical tumour extension, measuring approximately 5 × 3 centimetres, involving critical anatomical structures, leading to earlier assessments of inoperability.
Given the advanced stage of the disease and the patient’s relatively young age, the multidisciplinary tumour board at MGM Cancer Institute recommended neoadjuvant chemotherapy as the first step. According to Dr. M. A. Raja, Director and Senior Consultant in Medical Oncology, the aim of administering chemotherapy before surgery was to reduce tumour volume and improve the feasibility of definitive surgical management. After two cycles of chemotherapy, follow up PET scans demonstrated a good partial response, allowing the team to reconsider surgical intervention.
The patient subsequently underwent a complex composite resection procedure. This included complete removal of the anterior portion of the tongue, resection of the entire floor of the mouth, removal of the affected segment of the mandible, and excision of the hyoid bone. The objective was to achieve complete removal of all cancer involved tissue in a single, comprehensive operation.
Following tumour removal, reconstructive surgery was performed to restore structure and function. Using a free anterolateral thigh flap, healthy tissue was harvested from the patient’s left thigh and transplanted to reconstruct the tongue and oral cavity. This technique enabled restoration of form while supporting swallowing and speech functions post recovery.
According to Dr. Sivaram Ganesamoni, Head of Department and Senior Consultant in Surgical Oncology, the case demonstrated the importance of coordinated, multimodality care. He noted that close collaboration between medical oncology, surgical oncology, and reconstructive surgery was essential in managing a case of this complexity.
Postoperatively, the patient underwent radiation therapy to address any residual microscopic disease and reduce the risk of recurrence. At follow up, the patient was reported to be disease free and has returned to routine daily activities.
The case underscores how advances in chemotherapy, surgical techniques, and reconstruction, when combined through a multidisciplinary approach, can expand treatment options even in advanced oral cancer cases previously considered beyond surgical management.
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