How do you manage locally advanced adenocarcinoma of the base of tongue?

This is typically a surgical disease being minor-salivary gland, followed by adjuvant radiation therapy as needed. These do not normally respond to radiation therapy alone well at all. The question is what if the patient cannot tolerate or refuses surgical resection?

Agree- it is likely mucosal minor salivary gland origin. It is essential to consult a pathologist specializing in HNC regarding the exact pathologic diagnosis and differentiation. Low-grade indolent entities such as polymorphous adenoca require surgery alone if negative margins. Adenoid cystic ca requires postop RT to the primary and branches of the 5^th n if perineural invasion but usually not to regional LN. High grade lesions like salivary duct adenoca or cribriform adenoca have a high regiona...

Surgery followed by post op RT is standard for most salivary gland malignancies and adeno ca of tongue base is regarded as originating from the minor salivary glands. However, there are nuances to this case from a functional outcome viewpoint. For a relatively small and well lateralized tumor that could be resected with minimally invasive TORS (trans oral robotic surgery), the morbidity is acceptable. For larger tumors that these invariably tend to be, surgery would entail a total glossectomy, a...

Surgery and postop RT.

Agree with the previous answers/comments. I do, however, have an interesting case to share. A patient presented with extensive bilateral base of tongue adenocarcinoma infiltrating the vallecula with bilateral neck adenopathy. Interestingly, it was p16 positive. The patient declined primary surgical treatment that would have necessitated total glossectomy and partial laryngectomy. They were treated with definitive ChemoRT with Cisplatin and had complete clinical and radiologic response; now NED s...