Comparative analysis of the efficacy of definitive chemoradiation therapy and surgery followed by adjuvant radiation therapy in advanced-stage oral tongue cancer

Abstract

Summary. The aim of the study was to compare the efficacy of definitive chemoradiation therapy (CRT) and primary surgery followed by adjuvant radiotherapy (RT) or CRT in the management of patients with stage III–IVA–B resectable oral tongue squamous cell carcinoma (OTSCC). Materials and Methods: It is a retrospective analysis of the treatment outcomes of 211 patients with stage III–IVA–B resectable OTSCC. The patients were divided into two groups depending on the treatment modality: 114 patients received surgery followed by adjuvant RT or CRT (S-RT/CRT) group; the definitive CRT group consisted of 97 patients. Results: The five-year overall survival (OS) was 57.0% in S-RT/CRT group vs 20.4% in CRT group; the five-year disease-free survival (DFS) in S-RT/CRT group was 56.5% vs 15.5%, in the CRT group. Comparison of survival curves revealed statistically significant higher OS and DFS rates in patients of S-RT/CRT group as compared with those in CRT patients (hazard ratio = 0.33 (95% confidence interval 0.23–0.47), p < 0.001 vs hazard ratio = 0.25 (95% confidence interval 0.17–0.37), p < 0.001). A multivariate analysis showed a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.004), cervical lymph node involvement cN2 (p < 0.001), cN3 (p = 0.04) and treatment modality (p < 0.001) on OS. There was also found a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.02), cervical lymph node involvement cN2 (p < 0.001) and treatment modality (p < 0.001) on DFS. 18 (15.8%) patients of S-RT/CRT group and 13 (13.4%) patients (p = 0.77) of CRT group developed mandibular osteoradionecrosis. Conclusion: Primary surgery with adjuvant RT or CRT in advanced-stage resectable OTSCC significantly increases five-year OS and DFS rates as compared to those after definitive CRT.

Initial Experience of Intra-Arterial Chemotherapy Using a Novel External Carotid Arterial Sheath System Combined with Radiotherapy and Systemic Chemotherapy for Locally Advanced Tongue Cancer

“…In a randomized trial comparing surgery and adjuvant RT versus concurrent CRT in patients with advanced head and neck cancer, the subset analyses demonstrated that survival was significantly poorer in patients with oral cavity SCC who underwent CRT than in those who underwent surgery and RT (12% versus 68%, 5-year disease-specific survival; p = 0.038) [ 18 ]. Another comparative analysis also showed that the 5-year OS after definitive CRT in resectable stage III–IV tongue SCC was significantly inferior to that after primary surgery with adjuvant RT or CRT (20.4% vs. 57.0%) [ 19 ]. Therefore, surgery has been the standard treatment for locally advanced tongue cancer.…”