Twenty-four patients with squamous cell carcinoma of the tongue were treated with 5,000 cGy to 6,500 cGy pre-operative irradiation. Surgery usually consisted of resection of the tongue, possibly the floor of mouth, and modified or radical neck dissection. Musculocutaneous flaps for reconstruction were used in three cases and a forearm flap in one case. Despite the high radiation dose, no major difficulties were encountered at surgery or during the convalescence period, except for one osteoradionecrosis of the mandible, which was successfully treated by microvascular osteomyocutaneous grafting. Residual carcinoma was seen on histological examination of the excised tissue in 9 out of 18 (50 percent) patients who received ≥6,000 cGy, and in 4 out of 6 (67 percent) patients who received about 5,000 cGy tumour dose. The 2-year crude survival rate was 65 percent. The data suggest that high dose pre-operative irradiation is feasible and does not compromise surgical treatment.
