Improving the rate of negative margins after surgery for oral cavity squamous cell carcinoma: A prospective randomized controlled study

Amit, Moran; Na’ara, Shorook; Leider-Trejo, Leonor; Akrish, Sharon; Cohen, Jacob T.; Billan, Salem; Gil, Ziv

doi:10.1002/hed.24320

Cited by 66 publications

(93 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However these authors used frozen section analysis particularly for advanced tumour sizes (T3/T4) whereas single judgement on permanent sections was mainly applied to smaller (T1/T2) tumours. Moreover, when using frozen sections the authors took additional margins from the tumour bed although it seems currently proven that margin assessment from the tumour specimen leads to significant higher rates of negative permanent margins [26,27]. Reliance on tumour bed margins appears to be associated with even worse local control, perhaps due to the narrower initial resection [28].…”

Section: Discussionmentioning

confidence: 99%

Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

et al. 2016

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

et al. 2016

View full text Add to dashboard Cite

“…Oncologically sound treatment of early‐stage OCSCC can be achieved with complete tumor resection with wide free margins, which is the single most important prognostic factor for these patients . Although prospective controlled data are lacking, current guidelines indicate that an adequate margin is more than 5 mm from the tumor front . If the surgeon has achieved adequate resection in the early stage and the neck dissection shows negative nodes, there is no need for further treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Although patients with T1‐2N0M0 OCSCC can be treated with surgery alone, those with positive and close margins may benefit from adjunctive treatment . It has been suggested that adequate resection of OCSCC requires at least 5‐mm margins, although smaller margins have also been suggested . Because of the complexity of these tumors, clear margins are achieved in only 50% to 80% of patients treated at cancer centers .…”

Section: Introductionmentioning

confidence: 99%

The role of adjuvant treatment in early‐stage oral cavity squamous cell carcinoma: An international collaborative study

Fridman

Na’ara

Agarwal

et al. 2018

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…The influence of technique of margin assessment was also reported in a recent study from Israel. 20 That prospective, randomized clinical trial concluded that the rate of final negative margins using specimen-driven intraoperative margin assessment was significantly higher than that using patient-driven margin assessment.…”

Section: Discussionmentioning

confidence: 99%

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

Zanoni

Migliacci

et al. 2017

JAMA Otolaryngol Head Neck Surg

116

View full text Add to dashboard Cite

IMPORTANCE Resection of the primary tumor with negative margins is the gold standard treatment for squamous cell carcinoma of the oral tongue (SCCOT). A microscopically positive surgical margin is clearly associated with a higher risk for local recurrence, whereas a negative margin has traditionally been defined as greater than 5.0 mm clearance from the tumor, with lesser margins arbitrarily designated as close. The precise cutoff at which the risk for local recurrence with a close margin approximates that of a microscopically positive margin remains unclear. OBJECTIVE To determine whether the arbitrarily defined close margin (<5.0 mm) would portend as high a risk for local recurrence as a positive margin after resection of SCCOT. DESIGN, SETTING, AND PARTICIPANTS In this retrospective study, head and neck pathologists reviewed archived tumor specimens from 381 patients with SCCOT who underwent primary surgical resection at a tertiary care center from January 1, 2000, through December 31, 2012. Data were analyzed from November 15, 2015, to January 5, 2016. Time-dependent receiver operating characteristic curve analysis was used in patients who did not have a microscopically positive margin to determine an optimal margin cutoff for local recurrence-free survival (LRFS). Pathologic factors were assessed for LRFS in a multivariate Cox proportional hazards regression model. MAIN OUTCOMES AND MEASURES The primary end point was evaluation of the margin distance associated with LRFS. RESULTS Among the 381 patients included in the analysis (222 men [58.3%] and 159 women [41.7%]; mean [SD] age, 58 [14.7] years), the optimal cutoff associated with LRFS was determined to be 2.2 mm. This cutoff was compared with the traditionally accepted cutoff of 5.0 mm. Patients with a margin of 2.3 to 5.0 mm had similar LRFS as patients with a margin of greater than 5.0 mm (hazard ratio [HR], 1.31; 95% CI, 0.58–2.96), and all other comparisons were significantly different (HR for positive margin, 9.03; 95% CI, 3.45–23.67; HR for 0.01-to 2.2-mm margin, 2.83; 95% CI, 1.32–6.07). Based on this result, negative margins were redefined as those with a clearance of greater than 2.2 mm. In a multivariate model adjusting for pathologic factors, positive margins (adjusted HR, 5.73; 95% CI, 2.45–13.41) and margins of 0.01 to 2.2 mm (adjusted HR, 2.00; 95% CI, 1.13–3.55) were the variables most significantly associated with LRFS. CONCLUSIONS AND RELEVANCE In this study, local recurrence-free survival was significantly affected only with surgical margins of less than or equal to 2.2 mm in patients with SCCOT. This new definition of close margins stratifies the risk for local recurrence better than the arbitrary 5.0-mm cutoff that has been used.

show abstract

Improving the rate of negative margins after surgery for oral cavity squamous cell carcinoma: A prospective randomized controlled study

Abstract: Specimen derived margin assessment led to significant improvement in the rate of negative margins. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1803-E1809, 2016.

Cited by 66 publications

References 24 publications

Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

The role of adjuvant treatment in early‐stage oral cavity squamous cell carcinoma: An international collaborative study

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

Contact Info

Product

Resources

About