Postoperative Radiation Therapy in Oral Cavity Verrucous Carcinoma

Abstract

Objectives/Hypothesis We investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) and its effect on overall survival (OS) for patients with oral cavity verrucous carcinoma (VC). Study Design Retrospective cohort study. Methods A retrospective cohort study of the National Cancer Database (NCDB) from 2006 to 2015 was performed. Multivariable logistic regression was used to identify independent predictive factors associated with the use of PORT. Cox Regression survival and propensity score analyses were used to evaluate the effect of PORT on mortality. Results A total of 356 adult patients with primary oral cavity VC who underwent definitive surgical resection were identified. A total of 10.7% of patients underwent definitive surgical resection followed by PORT. Variables associated with PORT included distance to the hospital per 10 miles (adjusted odds ratio [aOR], 0.81 [95% confidence interval (CI), 0.70–0.95]) and stage III–IV disease (aOR, 12.13 and 23.92, respectively). Multivariable Cox regression survival analysis indicated no evidence of survival benefit in patients undergoing PORT compared to surgery alone (adjusted hazard ratio 1.50 [0.74–3.05], P = .23). Propensity score analysis also showed no OS benefit with the use of PORT (P = .41). Conclusions Variables associated with the use of PORT on multivariable analysis included closer distance to hospital and stage III–IV disease. No clear survival benefit with PORT was identified on either multivariable survival analysis or propensity score analysis. These results suggest that surgery alone with negative margins may be the optimal treatment for patients with oral cavity VC. Level of Evidence 4 Laryngoscope, 132:1953–1961, 2022

Oral verrucous carcinoma: a diagnostic and therapeutic challenge

“…7 In a recent retrospective cohort study of the National Cancer Database (NCDB), Naik et al showed that positive surgical margins were associated with significantly worse overall survival (OS) (hazard ratio [HR] 2.85, P = 0.006). 82 However, in those patients the use of PORT showed no OS benefit (HR 3.12, P = 0.072). These findings suggest that the role of PORT is limited in oral verrucous carcinoma, favouring surgical re-resection, when feasible, over adjuvant radiotherapy in patients with adverse pathologic features or clinically overt residual tumour after surgery.…”

“…positive or close surgical margins, pT3–T4 primary tumour, perineural and lymphovascular invasion). 67 , 82 Analysing the SEER database, however, Mohan et al . demonstrated a statistically significant improvement in DSS in patients solely operated compared to those receiving surgery and PORT.…”

“…These findings suggest that the role of PORT is limited in oral verrucous carcinoma, favouring surgical re-resection, when feasible, over adjuvant radiotherapy in patients with adverse pathologic features or clinically overt residual tumour after surgery. 82 …”

“…positive or close surgical margins, pT3-T4 primary tumour, perineural and lymphovascular invasion). 67,82 Analysing the SEER database, however, Mohan et al demonstrated a statistically significant improvement in DSS in patients solely operated compared to those receiving surgery and PORT. 7 In a recent retrospective cohort study of the National Cancer Database (NCDB), Naik et al showed that positive surgical margins were associated with significantly worse overall survival (OS) (hazard ratio [HR] 2.85, P = 0.006).…”

Elective Neck Dissection for cT1‐4 N0M0 Head and Neck Verrucous Carcinoma

“…1,[10][11][12] Factors that contribute to the exceedingly favorable prognosis of HNVC are its well-differentiated grading and predominantly indolent behavior. 13 Close cooperation between the pathologist and surgeon is necessary to accurately diagnose HNVC which may appear histologically benign but clinically malignant. [14][15][16] Metastasis to cervical lymph nodes is a key prognostic factor in determining staging, survival, and remission outcomes following surgical resection of HNSCC independent of treatment with adjuvant radiotherapy (RT) or chemoradiotherapy.…”