Postoperative Concomitant Chemoradiotherapy Improved Treatment Outcomes of Patients with Oral Cavity Cancer with Multiple-Node Metastases but No Other Major Risk Factors

Abstract

PurposeTo investigate the results of postoperative radiotherapy (PORT) for the treatment of pathologic N2b/c squamous cell carcinoma of the oral cavity (OSCC).Materials and MethodsThis study reviewed cancer registry data collected in our hospital from 1998 to 2009 with the following inclusion criteria: primary OSCC, treatment with radical surgery, and multiple nodal metastases. Patients who had extracapsular spreading of the lymph node metastases or positive resection margins or who refused to undergo PORT were excluded. The prescribed dose of PORT was 60–66 Gy. Concurrent chemotherapy was optional. Patient characteristics, treatment parameters and clinical outcome were recorded. The primary end point was overall survival, and the secondary endpoint was disease status.ResultsThere were 138 eligible cases, and the median follow-up period was 35 months. The 3-year overall survival rate was 56%. Univariate analysis revealed that pathologic T4 status (pT4), bone marrow invasion, and lymphatic invasion were significantly correlated with poor outcome (p<0.05). Multivariate analysis showed that pT4, lymphatic invasion, and the no concurrent chemotherapy were independent poor prognostic factors (p<0.05). Fifty-four patients had tumor recurrence. The 3-year recurrence-free survival rate was 59%. Skin invasion, pT4, and bone marrow invasion were correlated with poor prognosis in the univariate analysis (p<0.05). Only pT4 (p<0.01) and no concurrent chemotherapy (p = 0.03) were independently correlated with poor recurrence-free survival.ConclusionFor OSCC patients with multiple-node metastases without extracapsular spreading or positive resection margins, PORT without concurrent chemotherapy correlated to inferior outcome. Multiple lymph node metastases might be considered an indication for concurrent chemotherapy.

Postoperative radiotherapy of intermediate‐risk head and neck cancer in 134 patients: Does subset matter?

“…We observed poorer disease‐free survival in the NM ECS‐free subpopulation of IR‐HNC, which seems to emphasize the unsatisfactory results of PORT alone. This finding is in line with previous studies which have supported the use of postoperative chemoradiotherapy.…”

“…Fan et al retrospectively studied the efficacy of postoperative chemoradiotherapy for the treatment of OCSCC in 138 individuals with multiple NM without ECS or positive surgical margins. With a median follow‐up of 35 months, the 3‐year locoregional recurrence‐free survival rates for the patients treated with and without the adjuvant combined therapy scheme were 70% and 63%, respectively ( P = 0.71).…”

“…Because it is a retrospective study, all relevant information may not have been available, and there is a possibility of selection bias. Despite the shortcomings, the primary intent of this report is to provide an additional account to published literature about selected subsets of IR‐HNC.…”

Survival outcomes for postoperative chemoradiation in intermediate‐risk oral tongue cancers

“…Prabhu et al also demonstrated that MLN ratios ≥20% indicated increased risks for locoregional recurrence and death after RT, suggesting the need of treatment intensification. Similarly, Fan et al analyzed the benefit of adjuvant CRT in patients with oral cavity cancers and multiple metastatic lymph nodes. Here, the addition of chemotherapy to adjuvant RT improved relapse‐free survival but not OS.…”

“…Although a combined analysis of EORTC 22931 and RTOG 9501 did not suggest any benefit, other retrospective studies support a role for treatment intensification in patients with multiple metastatic lymph nodes and/or pT3- Abbreviations: Academic, academic/research program; Com Cancer, comprehensive community cancer program; Com Other, community cancer program or integrated network cancer program; HR, hazard ratio; LVSI, lymphovascular space invasion; MLNs, metastatic lymph nodes; N.D., not determined; S1CRT, surgery 1 postoperative chemoradiotherapy; S1RT, surgery 1 postoperative radiotherapy. 16 analyzed the benefit of adjuvant CRT in patients with oral cavity cancers and multiple metastatic lymph nodes. Here, the addition of chemotherapy to adjuvant RT improved relapse-free survival but not OS.…”