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

Spiotto, Michael T.; Jefferson, Gina D.; Wenig, Barry L.; Markiewicz, Michael R.; Weichselbaum, Ralph R.; Koshy, Matthew

doi:10.1001/jamaoto.2017.0012

Cited by 65 publications

(44 citation statements)

References 19 publications

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“…To date no prospective study has examined potential differences in baseline comorbidity scores and OS in people treated surgically compared to those who underwent conservative management for head and neck cancer. In our large cohort, the distribution of treatment modalities among cancer subsites reflects current standard of care . Oral cavity cancers were predominantly managed surgically whereas over two‐thirds of oropharyngeal and laryngeal cancers received nonsurgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In our large cohort, the distribution of treatment modalities among cancer subsites reflects current standard of care. [38][39][40][41] Oral cavity cancers were predominantly managed surgically whereas over two-thirds of oropharyngeal and laryngeal cancers received nonsurgical treatment. In univariate analysis, treatment modality was independently associated with comorbidity.…”

Section: Discussionmentioning

confidence: 99%

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Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

et al. 2018

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Background People with head and neck cancer (HNC) have higher comorbidity levels but it remains unclear if pre-treatment comorbidity is an independent prognosticator in HNC. Methods Survival analyses were performed using data from participants in a UK multicentre cohort study with cancers of the oral cavity (n = 668), oropharynx (n = 1,074) and larynx (n = 530). Survival analyses were incrementally adjusted for age, gender, marital status, income, education, stage, alcohol and smoking. Results After adjusting for demographic, clinical and behavioural confounders, higher baseline comorbidity was associated with reduced overall survival (mild comorbidity HR 1.4, 95% CI 1.1, 1.7; moderate comorbidity HR 1.7, 95% CI 1.3, 2.2; severe comorbidity HR 2.8, 95% CI 1.9, 4.; p-trend<.001). Conclusions Our findings suggest that comorbidity is an independent prognosticator for overall survival in HNC. Comorbid illnesses should be considered in the assessment and treatment planning of people with HNC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

et al. 2018

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“…Comparing survival between cohorts of different age categories is difficult due to expected differences in life expectancy. Some studies confirm poorer survival in the elderly after multimodality treatment, others report comparable survival in the elderly to the younger cohorts . Concerning the rate of treatment‐related death, Sarini et al did not find any age‐specific differences.…”

Section: Adverse Events and Survival After Different Treatment Modalimentioning

confidence: 96%

“…According to our search criteria, 2543 papers were initially identified. After sorting and removal of duplicates, 82 papers that fully fit our inclusion criteria were retrieved, reviewed in detail, and summarized in Tables according to the modality of treatment used: RT, systemic therapy (CT or targeted therapy), surgery, or multimodal therapy …”

Section: Introductionmentioning

confidence: 99%

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

et al. 2019

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Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age-related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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“…While even the most modern radiologic investigative tools have a sensitivity of 70% to 80% for detecting nodal metastases, END facilitates appropriate upstaging of patients with occult disease and optimization of adjuvant treatment for locoregional control. In oral cavity SCC, the addition of END is feasible as most are undergoing primary site surgical resection according to NCCN guidelines with studies implicating a >15% survival benefit with surgery plus adjuvant radiation vs definitive chemoradiation …”

Section: Introductionmentioning

confidence: 99%

Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival

Obayemi

Cracchiolo

Migliacci

et al. 2019

Journal of Surgical Oncology

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Background and Objectives: The reported risk of nodal metastasis in hard palate and upper gingival squamous cell carcinoma (SCC) has been inconsistent with inadequate consensus regarding the utility of neck dissection in the clinically negative (cN0) neck. Materials and Methods: Using the National Cancer Database, cN0 patients diagnosed with SCC of the head and neck with the subsites of the hard palate and upper gingiva were identified from 2004 to 2014. Results: A total of 1830 patients were identified, and END was performed on 422 patients with cN0 tumors. Pathologically positive nodes occurred in 14% (59/422) of patients in this cohort. Higher tumor stage, academic hospital type, and large hospital volume (>28 cancer-specific cases/year) were associated with a higher likelihood of END both in univariate and multivariate analyses (P < .05). Patients >80 years of age were less likely to receive END on multivariate analysis (OR 0.52, 0.32-0.84). No variables, including advanced T stage, predicted occult metastases. Cox proportional hazards regression analysis showed that patients who underwent END demonstrated improved OS over an 11-year period (hazard ratio 0.75, P = .002). On subgroup analysis, this improvement was significant in patients with both stage T1 and T4 tumors.Conclusions: Tumor stage, hospital type, and hospital volume were associated with higher rates of END for patients with cN0 hard palate SCC and after controlling for clinical factors, END was associated with improved overall survival. K E Y W O R D S carcinoma squamous cell head and neck, gingiva, hard palate, logistic models, neck dissection, prevalence How to cite this article: Obayemi A Jr, Cracchiolo JR, Migliacci JC, et al. Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival.

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

Abstract: Compared with CRT, S+PORT was associated with improved survival for locally advanced OCSCCs, especially in T3 to T4a disease. These data support the use of surgery as the initial treatment modality for operable OCSCCs.

Cited by 65 publications

References 19 publications

Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival

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