Chemoradiation for patients with advanced oral cavity cancer

Abstract

Objectives/Hypothesis:Patients with advanced oral cavity cancer (OCC) typically have not been enrolled in clinical trials utilizing contemporary multimodality strategies. There exist dogmatic expectations of inferior outcome in OCC patients secondary to ineffectiveness of treatment and unacceptable toxicity. The purpose of this study was to analyze survival, swallowing function, and incidence of osteoradionecrosis (ORN) of patients with stage III/IV OCC who have undergone primary concomitant chemoradiotherapy (CRT).Methods:All advanced OCC patients who were enrolled in University of Chicago concomitant CRT protocols from 1994 to 2008 were reviewed. One hundred eleven newly diagnosed advanced OCC patients were evaluated. We performed a subset analysis of 27 additional advanced OCC patients who underwent surgery followed by postoperative CRT. Swallowing function was assessed via oropharyngeal motility study, and a Swallowing Performance Status Scale score was assigned. Presence of clinically significant ORN was documented.Results:Median follow‐up was 3.25 years. Five‐year overall and progression‐free survival was 66.9% and 65.9%, respectively. There was no difference in overall or progression‐free survival when the surgery‐first group was compared with the primary CRT group (P = .88 and P = .86 respectively). Function, without gastric tube requirement, was excellent, with 92.2% of patients able to maintain weight via oral route. Incidence of ORN was 18.4%, occurring in nine of 49 patients evaluated.Conclusions:Our data support the use of primary CRT as a viable treatment option for patients with advanced OCC. Survival is high, and overall function for the majority of patients is satisfactory. Patients with T4 oral tongue cancer may be spared total glossectomy. The incidence of ORN may be considered acceptable, in light of the benefits of enduring life and function. Laryngoscope, 2010

Squamous Cell Carcinoma of the Tongue Dorsum: Incidence and Treatment Considerations

“…Disease outcomes 5 years after surgery or systemic chemoradiotherapy were not significantly different (61 vs. 70 % for the local control rate, 56 vs. 55 % for the progression-free rate, and 27 Vs. 40 % for the overall survival rate, respectively). McDowell et al [20] concluded that chemoradiotherapy may be a reasonable alternative to surgery in patients with T4 tongue cancer, while Stenson et al [21] reported that systemic chemoradiotherapy in such patients may negate the need for total glossectomy. Pederson et al [22] reported that the rates of 5-year locoregional progression-free survival, overall survival, and disease-free survival in 127 patients with stage III or IV base of tongue cancer treated with systemic chemoradiotherapy was 87, 58.2, and 46 %, respectively.…”

Prediction and monitoring of the response to chemoradiotherapy in oral squamous cell carcinomas using a pharmacokinetic analysis based on the dynamic contrast-enhanced MR imaging findings

“…To reduce the functional damage caused by surgery, neoadjuvant chemotherapy and radiotherapy have become primary treatments for head and neck cancer. The precise determination of the tumour response to the preoperative chemoradiotherapy (CRT) before surgery is of great importance in making clinical decisions [1][2][3][4][5].…”

Surgical Treatment Is Recommended for Advanced Oral Squamous Cell Carcinoma

“…Moreover, one of these 2 patients showed regional recurrence, and only one stage IV patient could demonstrate loco-regional control after CRT. Although some previous reports have described the effectiveness of RT/CRT for advanced head and neck SCC (Doweck et al 2008;Stenson et al 2010), non-surgical treatment for advanced oral SCC has reported not to improve prognosis in Japanese Patients (Inagi et al 2002;Umeda et al 2004). These results therefore allow us to consider that advanced oral SCC, excluding tongue SCC, might have a worse response to CRT than other head and neck SCC, and careful examination for any local recurrence should be regularly performed even if a complete remission was obtained, because of their high rates of local recurrence after CRT.…”

“…Recent research revealed that chemo-radiation therapy (CRT) seems to be effective for advanced head and neck squamous cell carcinomas (head and neck SCC) including oral squamous cell carcinomas (oral SCC) (Robbins et al 2005;Doweck et al 2008;Fuwa et al 2008;Stenson et al 2010). However, the treatment strategies have not yet been established for oral SCC, excluding tongue SCC, such as SCC in buccal mucosa, gingiva, hard palate and oral floor, because of the rare incidence (Ariyoshi et al 2008).…”