Postoperative radiotherapy for patients at high risk of recurrence of oral cavity squamous cell carcinoma. (6th November 2014)

• Record Type: Journal Article
• Authors: Herman, Michael P.; Dagan, Roi; Amdur, Robert J.; Morris, Christopher G.; Werning, John W.; Vaysberg, Mikhail; Mendenhall, William M.
• Is Part Of: Laryngoscope. Volume 125:Number 3(2015:Mar.)
• Page Start: 630
• Page End: 635
• Publication Date: 2014-11-06
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24938
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24938-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate the efficacy of postoperative radiotherapy for oral cavity squamous cell carcinoma (OCSCC) by comparing outcomes of high‐risk subgroups.</p> </sec> <sec id="lary24938-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective review.</p> </sec> <sec id="lary24938-sec-0003" sec-type="section"> <title>Methods</title> <p>Outcome study of 139 patients with OCSCC treated with gross total resection and postoperative radiotherapy ± chemotherapy and at least one high‐risk pathologic finding: positive margin (52%), close (0.1–5 mm) margin (27%), or extracapsular nodal extension (ECE; 45%).</p> </sec> <sec id="lary24938-sec-0004" sec-type="section"> <title>Results</title> <p>Median follow‐up was 2.3 years. Local‐regional control (LRC), freedom from distant metastases, cause‐specific survival, and overall survival (OS) rates at 5 years were 64%, 85%, 51%, and 36%, respectively. Five‐year LRC for negative (>5 mm), close (0.1–5 mm), and positive (carcinoma in situ or tumor at ink) margins were 73%, 83%, and 63%, respectively (<italic>P</italic> = not significant). Five‐year neck control was 100% for node‐negative patients, 88% for node‐positive patients with no ECE, and 86% for node‐positive patients with ECE (<italic>P</italic> = not significant). The combination of close/positive margin and ECE resulted in worse 5‐year LRC (37% vs. 70%, <italic>P</italic> < 0.001), progression‐free survival (26% vs. 60%, <italic>P</italic> < 0.001), and OS (13 vs. 43%, <italic>P</italic> < 0.001) compared with a single high‐risk indication.</p> </sec> <sec id="lary24938-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Local‐regional control was the predominant mode of treatment failure. Outcome in our series was not statistically different based on margin status or nodal ECE. This finding is indirect evidence of the efficacy of adjuvant radiotherapy in this setting.</p> </sec> <sec id="lary24938-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4. <italic>Laryngoscope</italic>, 125:630–635, 2015</p> </sec> </abstract>