Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501)

Bernier, Jacques; Cooper, Jay S.; Pajak, Thomas F.; Glabbeke, M. van; Bourhis, Jean; Forastiere, Arlene A.; Özşahin, Esat Mahmut; Jacobs, John R.; Jassem, Jacek; Ang, K. Kian; Lefèbvre, Jean Louis

doi:10.1002/hed.20279

Cited by 1,500 publications

(1,191 citation statements)

References 13 publications

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“…Consequently, patients can be treated with an appropriate adequate post-operative therapy on the basis of pathological evaluation. Bernier reported that the addition of concomitant cisplatin to postoperative radiotherapy improves outcomes in patients with ECS who are medically fit to receive chemotherapy [14].…”

Section: Discussionmentioning

confidence: 99%

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Tsushima

Sakashita

Homma

et al. 2016

Eur Arch Otorhinolaryngol

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Purpose. Prophylactic neck dissection (PND) for patients with clinically N0 (cN0) tongue carcinoma remains controversial. We assessed the efficacy of PND for patients with cN0 tongue squamous cell carcinoma (SCC) and investigated the prognostic role of tumor thickness as assessed by diagnostic imaging in predicting the risk of nodal micrometastasis or late nodal recurrence. Methods. Eighty-eight patients with cN0 tongue carcinomas underwent surgical treatment. Tumor thickness was measured from magnetic resonance (MR) images or computed tomography (CT) scans. Results. The overall survival rates of patients with or without PND were 94% and 81%, respectively (p=0.2857). MR images or CT scans were available for 68 patients. A tumor thickness ≧10mm or ≧5mm did not increase the probability of nodal metastasis, with late nodal metastasis observed in 15% of patients with graphically undetected small tumors. Conclusions. PND appears to have the potential to improve overall survival for patients with cN0 tongue SCC. Careful follow-up management or PND is considered to be needed regardless of tumor thickness in the pre-treatment evaluation

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Section: Discussionmentioning

confidence: 99%

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Tsushima

Sakashita

Homma

et al. 2016

Eur Arch Otorhinolaryngol

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“…A relatively recent, prospective, randomized controlled trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) suggested that intensification of therapy, not only with PORT but also with concomitant chemotherapy, is warranted with a margin <5 mm in head and neck SCC, including SCC of the oral cavity. 1,3 Another trial conducted in parallel by the US Radiation Therapy Oncology Group (RTOG) supported the role of CERT for high-risk margins, which, however, was defined as tumor at the resected margin. 2 Note that, in addition to margin status, the EORTC trial defined high risk as extracapsular extension (ECE) of lymph node disease, clinical involvement of lymph nodes There was a strong association between the number of adverse features and local control.…”

Section: Discussionmentioning

confidence: 99%

Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma

Ch’ng

Corbett-Burns

Stanton

et al. 2013

Cancer

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BACKGROUND: There are major variations between institutions regarding postoperative adjuvant therapy for adverse features in patients with oral squamous cell carcinoma (SCC). The authors' practice has been to not recommend any adjuvant therapy on the basis of close (<5 mm but uninvolved) margins unless there are additional adverse features. The primary objective of this study was to assess whether the local control achieved in this patient cohort was acceptable. METHODS: In this single-institution, retrospective analysis, local control was the primary endpoint, and disease-specific survival (DSS) was the secondary endpoint. Differences in survival were determined using the log-rank test, and survival curves were generated using the Kaplan-Meier method. RESULTS: One hundred forty-four patients (79 men and 65 women; median age, 64.1 years; mean follow-up, 3.3 years) underwent surgery alone for oral SCC with curative intent and were recorded as having close tumor margins on histology. The local control rate for all patients who underwent surgery alone was 91% (95% confidence interval, 81.9%-95.2%), and the DSS rate was 84% (95% confidence interval, 74.0%-89.9%) at 5 years. There was no pattern of worse local control or DSS rates with the ordered stratification of close margins. The 5-year local control rates for having 0, 1, 2, and 3 additional adverse features were 100%, 96%, 83%, and 71%, respectively (P 5.004; trend test). CONCLUSIONS: Surgery alone without postoperative adjuvant therapy offered acceptable local control in patients who had close margin status as their only adverse feature and may be reasonable in the presence of 1 other adverse clinicopathologic feature.

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“…The outcome of positive margins on further therapy reported by Binahmed et al [10] suggests that the patients with positive margins did not significantly benefit from radiotherapy alone and recurrences among them were greater than the patients with initial clear margins, kovacs et al has reported better survival rates with chemo radiotherapy in such instances [16]. Combined analysis of RTOG and EROTC trials suggests improved outcome of patients with involved margin and perinodal spread on delivery of adjuvant concurrent chemo radiation [17].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Frozen Section in T1, T2 Carcinoma of Oral Cavity

Gokavarapu

Rao

Patnaik

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Complex anatomy of oral cavity makes it difficult for a surgeon to assess margins of oral cancer accurately and positive margins compromise loco regional disease control, thus surgeon may rely on frozen section assessment for marginal status. We discussed the prognostic value of frozen section in early carcinoma of oral cavity. 90 patients with pT1 and pT2 oral cavity cancer operated from January 2010 to December 2011 under single consultant surgeon were retrospectively evaluated. Log rank test and multivariate cox regression model was used for testing frozen section against the survival and recurrence free status. Survival of patients with positive or negative frozen section was significant (p = 0.037), Survival of patients with positive or negative histology report was significant (p = 0.004), however; prognosis of patients with positive margins despite revision under frozen control was poorer to the patients with negative margin. Frozen section assessment is accurate but their use in the surgery of oral cavity cancer might not improve loco regional disease control or survival when used routinely.

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Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501)

Cited by 1,500 publications

References 13 publications

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma

Prognostic Value of Frozen Section in T1, T2 Carcinoma of Oral Cavity

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