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Carcinoma of tongue is one of the most notorious cancers of oral cavity. Multivariate analysis have shown that the parameter with greatest influence on survival is tumor thickness especially in carcinoma tongue. To study the pattern of lymphatic metastasis in oral tongue in relation to the depth of tumor. This is a prospective study of 60 patients over a period of 4 years. Squamous cell carcinoma of anterior twothird (oral tongue) which were managed by upfront surgery were considered in the study. USG tongue was done in a few cases (25 out of 60) but was not a mandatory criteria for inclusion or exclusion of the case. The measurements for depth of invasion were made from surface of mucosa to maximal depth by an ocular micrometer. Frequency, proportions and percentages were used to analyse the data. Out of 15 patients who had tumor thickness less than 5 mm, two had nodal metastasis i.e. 13%, whereas 28 patients out of 45 patients with tumor thickness more than 5 mm had nodal disease i.e. 62%. Out of 60 patients enrolled, 13 (21.66%) lost to follow up by the end of 1 year. Of remaining 47 patients seven (14.89%) presented with recurrence (four nodal and three local), three out of which underwent second surgery and four were referred for palliative care. All the four patients referred for palliative care died within 1 year of surgery. As evident from above study only two patients had positive nodal disease when the depth of the tumor was less than 5 mm. There is no role of observation of neck in carcinoma tongue, however if observation is being planned then preoperative ultrasonography of tongue should be done and tumors more than 5 mm should at least be offered extended supraomohyoid neck dissection. Chance of level V involvement is negligible and can be omitted in N0 and N1 neck.

Background: The survival benefit of neoadjuvant therapy in resectable carcinoma esophagus has been elucidated. We performed a meta-analysis in light of new studies and long-term results of past trials. The search strategy was refined to include only "neoadjuvant" so that any bias by adjuvant treatment is eliminated. Methods: A detailed search of MEDLINE, Embase, and Cochrane Library was done. Only published randomized English language trials were included. Data were categorized as neoadjuvant concurrent chemoradiation (NACRT), neoadjuvant chemotherapy (NACT), neoadjuvant radiotherapy (NART), and neoadjuvant sequential chemoradiotherapy (SCRT). Meta-analysis was done using odds ratio (OR) and 95% CI using fixed/random effects model. Heterogeneity was tested by chi-square and I 2 test. Z probability calculated significant difference across subgroups. Outcomes assessed were overall survival (OS) and disease-free survival (DFS) at 3 and 5 years, respectively, mortality (30/90 day) and failures (local/systemic). Results: Twenty-five randomized trials involving 5272 patients were included for quantitative analysis. NACRT was evaluated in 12 studies (2676 patients). Superior 3-year OS (OR = 0.68 CI 0.52-0.90, p = 0.007), 3-year DFS (OR = 0.55 CI 0.45-0.68, p = 0.00001), and 5-year DFS (OR = 0.59 CI 0.47-0.74, p = 0.00001), with lower failures (OR = 0.52 CI 0.37-0.73, p = 0.0001), were seen in favor of NACRT at the cost of increased perioperative mortality (OR = 1.79 CI 1.15-2.80, p = .01). However, 5-year OS (OR = 0.78 CI 0.60-0.1.01, p = 0.06) was not found to be significantly superior. NACT, NART, and SCRT were not found to have any benefit over surgery alone. Conclusion: This meta-analysis presents strong evidence favoring NACRT over upfront surgery. It also shows no survival advantage of neoadjuvant chemotherapy.

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