Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of the Head and Neck

Cooper, Jay S.; Pajak, Thomas F.; Forastiere, Arlene A.; Jacobs, John R.; Campbell, Bruce H.; Saxman, Scott; Kish, Julie A.; Kim, Harold E.; Cmelak, Anthony J.; Rotman, Marvin; Machtay, Mitchell; Ensley, John F.; Chao, K.S. Clifford; Schultz, Christopher J.; Lee, Nancy; Fu, Karen K.

doi:10.1056/nejmoa032646

Cited by 2,814 publications

(2,341 citation statements)

References 18 publications

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“…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. The 5-year local control rates for patients who had 0, 1, 2, and 3 adverse features were 100%, 96%, 83%, and 71%, respectively (P 5.004).…”

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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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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“…To improve the result, radiotherapy or chemoradiotherapy is often added postoperatively [1,7]. However, toxicities of the adjuvant therapy are considerable, predictive factors in each patient should be identified and taken to evaluate risk and benefit.…”

Section: Discussionmentioning

confidence: 99%

“…The cause of poor survival is related to locoregional recurrence. Adjuvant radiotherapy with or without chemotherapy has been used to improve the outcome in ''high risk'' squamous cell carcinoma of the head and neck [1,7]. The frequently identified high-risk pathologic features are close or positive surgical margins and extracapsular nodal extension which are usually not found in early-stage OTC [5,6].…”

Section: Introductionmentioning

confidence: 99%

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

Sittitrai

Srivanitchapoom

Mahanupab

et al. 2012

Indian J Otolaryngol Head Neck Surg

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To determine predictive factors which affect local and regional recurrence of T1-2N0-1M0 oral tongue carcinoma (OTC). Records of 42 patients with T1-2N0-1 M0 OTC were reviewed. The clinical characteristics, histopathological data, disease recurrence and survival rate were analyzed. Descriptive statistics and Kaplan-Meier survival analysis were used. The median follow up was 38 months. The 2-year overall survival and disease-free survival rates were 85.7 and 55.6 % respectively. At the 2 year analysis, there were surgical margin\5 mm (p value = 0.01), tumor thickness [7 mm (p value = 0.03), perivascular and perilymphatic invasion (p value = 0.01) affected on local recurrence and perivascular and perilymphatic invasion were also predictors for regional recurrence (p value = 0.04). The surgical margin status, tumor thickness, perivascular and perilymphatic invasion represented significant predictive factors for local recurrent OTC. Postoperative adjuvant therapy should be considered in these groups.

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“…It has been reported that the gross tumor volume is statistically significantly larger with 18F-FDG PET/CT–based assessment than with CT-based assessment 5152. There is still a high risk of locoregional recurrence (18%-31%) and distant metastasis (20%-25%) despite aggressive treatment 5354. The sensitivity, specificity and accuracy of 18 F-FDG PET/CT in restaging patients with head and neck cancer are 88%, 78% and 86%, respectively 55…”

Section: Methodsmentioning

confidence: 99%

¹⁸F-FDG PET/CT Imaging In Oncology

Almuhaideb

Παπαθανασίου

Bomanji

2011

Annals of Saudi Medicine

275

123

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Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of managment is changed. This review provides guidance for oncologists/ radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.

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Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of the Head and Neck

Cited by 2,814 publications

References 18 publications

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

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

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

¹⁸F-FDG PET/CT Imaging In Oncology

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Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of the Head and Neck

Cited by 2,814 publications

References 18 publications

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

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

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

18F-FDG PET/CT Imaging In Oncology

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¹⁸F-FDG PET/CT Imaging In Oncology