Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Organ Preservation of Locoregionally Advanced Oral Cavity Cancer

Pederson, Aaron; Salama, Joseph K.; Witt, Mary Ellyn; Stenson, Kerstin; Blair, Elizabeth A.; Vokes, Everett E.; Haraf, Daniel J.

doi:10.1097/coc.0b013e3181e8420b

Cited by 30 publications

(46 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of osteoradionecrosis in the present study was 6.8%, which falls in line with other studies – ranging from 5.9% to 18.4% – in which both conventional and IMRT were utilized [9,25]. However, as IMRT has been shown to afford lower rates osteoradionecrosis, rates in modern IMRT series have dropped to between 1% and 14% [14,15,26,27]. In patients who are surgical candidates, however, post-operative IMRT rather than IMRT alone may provide the greatest benefit [15].…”

Section: Discussionsupporting

confidence: 89%

“…The use of IMRT has shown promise in improving patient outcomes; rates of LRC have even exceeded 90% in smaller studies utilizing CCRT with IMRT rather than 3DCRT [14]. The rate of osteoradionecrosis in the present study was 6.8%, which falls in line with other studies – ranging from 5.9% to 18.4% – in which both conventional and IMRT were utilized [9,25].…”

Section: Discussionsupporting

confidence: 85%

“…Additionally, due to either comorbidities or the initiation of treatment before the routine use of chemotherapy along with RT for locally advanced disease in the year 2000, only 62% of patients were treated with CCRT, which also likely resulted in inferior outcomes. Accordingly, in other definitive series in which OS was greater (between 67% and 76% at 5 years), all patients had received CCRT, which has been shown to result in significantly better rates of OS and LRC [9,14,16]. Our 5-year rates of LRC and FFDM were 37% and 70%, respectively, which were still comparable to similar studies of definitive treatment for OCC (Table 5).…”

Section: Discussionsupporting

confidence: 81%

“…The 5-year OS was 15%, which was lower than other recent studies examining similarly large proportions of advanced-stage cancer, with OS rates between 37% and 76% (Table 5) [9,14,15]. Importantly, our series contained a significant proportion of patients with medically unresectable disease or who were medically unfit for surgery.…”

Section: Discussioncontrasting

confidence: 55%

See 3 more Smart Citations

Definitive chemoradiation for primary oral cavity carcinoma: A single institution experience

et al. 2015

View full text Add to dashboard Cite

Summary Objectives While surgery with or without adjuvant radiation therapy (RT) is the standard of care for oral cavity cancer (OCC), a select group requires nonsurgical treatment. We provide a single-institution experience using definitive chemotherapy and RT for primary OCC. Materials and methods We examined 73 patients with previously untreated, non-metastatic primary OCC treated definitively from 1990 to 2011. There were 39 male and 34 female, with a median age of 63 years (range, 35–89). The disease distribution was Stage I and II (7% each), Stage III (14%), and Stage IV (73%). Oral tongue was the most common (48%), followed by floor of mouth (19%), retromolar trigone (13.7%), and others (8.2%). Median tumor dose was 70 Gy. Sixty-two percent of patients (n = 45) were treated with concurrent chemotherapy, predominantly platinum-based. Results Median follow-up among surviving patients was 73.1 months (interquartile range 14.2– 81.4 months). Actuarial 5-year overall survival was 15%. Incidences of locoregional and distant failures were 41.1% and 20.5%, respectively. Kaplan-Meier estimated 5-year rates of locoregional control and freedom from distant metastasis were 37% and 70%, respectively. Mucositis was the most common ≥ Grade 3 acute toxicity (49%). Incidences of Grade 3 late dysphagia and trismus were 15% and 13%, respectively. Conclusion This study demonstrates over 20 years of experience using definitive chemoradiation for OCC at our institution. Our results illustrate the challenges in treating patients with advanced disease who are not surgical candidates, and the need for adequate and early treatment to prevent distant disease and improve survival outcomes.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 55%

See 2 more Smart Citations

Definitive chemoradiation for primary oral cavity carcinoma: A single institution experience

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Retrospective analysis of three small phase II studies evaluating outcomes after definitive CRT for OCSCC showed 5-year overall survival rates of 56 -76%, death as a result of CRT occurring in 7.2 - 7.6%, and ORN in 14 -18% of their patient population. 16-18 These results demonstrate better OS compared to our IS cohort, but survival appears to be equivocal or worse compared to our surgical cohort in regards to OS. Additionally, there were higher rates of treatment related deaths and post-treatment complications in both our IS cohort and these IS and CRT trials compared to our surgical cohort.…”

Section: Discussionsupporting

confidence: 44%

Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients With Advanced Oral Cavity Carcinoma

Chinn

Spector

Bellile

et al. 2014

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Objective To evaluate the efficacy of an induction selection(IS) concurrent chemoradiation(CRT) protocol versus primary surgical extirpation in advanced oral cavity squamous cell carcinoma(OCSCC). Design Retrospective matched cohort study Setting Tertiary care hospital Patients Nineteen patients with resectable stage III/IV OCSCC were into a phase II IS trial. Patients with >50% response underwent concurrent CRT and patients with <50% underwent surgical treatment and radiation therapy. A comparison cohort of patients treated with primary surgical extirpation was selected from the University of Michigan during a similar time period and frequency matched for inclusion criteria and patient characteristics to those patients included from the phase II IS trial. There was no difference in age, gender, pre-treatment AJCC-stage, T-classification, N-classification, smoking status, alcohol status, or tumor subsite between the two groups. Median follow-up was 9.4-years in the IS cohort and 7.1-years in the surgical cohort. Main Outcome Measures Overall Survival(OS), Disease-specific survival(DSS) and . Local-regional control(LRC) Results OS at 5-years was 32% in the IS group and 65% in the surgical cohort. DSS at 5-years was 46% in the IS group and 75% in the surgical cohort. LRC at 5-years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better OS, DSS and LRC outcomes (p=0.03,p=0.001 and p=0.0005,respectively) in the surgical cohort. Conclusion Primary surgical treatment showed significantly better OS, DSS and LRC compared to IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol versus primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.

show abstract

Differences in Survival With Surgery and Postoperative Radiotherapy Compared With Definitive Chemoradiotherapy for Oral Cavity Cancer

Spiotto

Jefferson

Wenig

et al. 2017

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Organ Preservation of Locoregionally Advanced Oral Cavity Cancer

Abstract: Concurrent chemoIMRT results in promising locoregional control for oral cavity squamous cell carcinomas with acceptable toxicity.

Cited by 30 publications

References 37 publications

Definitive chemoradiation for primary oral cavity carcinoma: A single institution experience

Definitive chemoradiation for primary oral cavity carcinoma: A single institution experience

Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients With Advanced Oral Cavity Carcinoma

Differences in Survival With Surgery and Postoperative Radiotherapy Compared With Definitive Chemoradiotherapy for Oral Cavity Cancer

Contact Info

Product

Resources

About