Clinical Paper
Head and Neck Oncology
Postoperative adjuvant therapy for patients with loco-regionally advanced oral squamous cell carcinoma who are at high risk of recurrence

https://doi.org/10.1016/j.ijom.2019.12.007Get rights and content

Abstract

Extranodal extension (ENE) of lymph node metastasis and the presence of a positive or close margin (PCM) are major risk factors for head and neck squamous cell carcinoma recurrence. This retrospective multicentre cohort study compared the prognostic impact of postoperative radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) in oral squamous cell carcinoma (OSCC) patients at high risk of recurrence. One hundred and eighteen patients with PCM and/or ENE who underwent definitive surgery plus either adjuvant RT or CCRT using cisplatin for OSCC were investigated. The cohort-wide 5-year loco-regional control (LRC), disease-free survival (DFS), and overall survival (OS) rates (the main outcome measures) were 54.3%, 35.8%, and 43.2%, respectively. Multivariate analysis showed that age ≥64 years (hazard ratio (HR) 0.584), cT3–4 stage (HR 1.927), ≥4 metastatic lymph nodes (HR 1.912), and PCM (HR 2.014) were significant independent predictors of OS. Moreover, postoperative CCRT with cisplatin was associated with a significantly improved LRC rate, but not with improved DFS or OS rates, compared to postoperative RT (HR 0.360). Given that CCRT with cisplatin does not significantly improve survival, additional clinical trials will be required to validate new regimens that further improve the outcomes of patients with loco-regionally advanced OSCC going forward.

Section snippets

Patients

This multicentre retrospective cohort study included all patients with OSCC who also had PCM and/or ENE and who underwent definitive surgery with adjuvant RT or CCRT at six institutions belonging to the Japan Oral Oncology Group between 2002 and 2011. PCM was defined as a microscopically positive or close margin (<5 mm). Treatments with adjuvant RT versus CCRT were based on institutional policies and patient preferences, and therefore varied across the institutions. Patients who had undergone

Patient and treatment characteristics

The demographic characteristics and clinicopathological factors of the study patients are summarized in Table 1. There were more male patients than female patients (male to female ratio 1.7:1), and the median patient age was 64 years (range 25–88 years). The tongue (n = 49, 41.5%) was the most common primary tumour site. Most patients presented with clinical T3–4 stage (n = 79, 66.9%). The clinical N stage was N0–1 in 43 patients (36.4%) and N2–3 in 75 (63.6%). Thirty-eight patients (32.2%) had

Discussion

Postoperative radiation has been widely used to treat patients with advanced HNSCC since 1970, when radiation was shown to be effective against residual tumours post-surgery11. However, the 5-year OS rate was approximately 40%, which was not satisfactory11; hence, additional strategies such as adding chemotherapy to RT have been employed3, 4, 12. Postoperative adjuvant therapy for locally advanced HNSCC is recommended for patients with high risk factors for recurrence such as PCM and/or ENE2, 6

Funding

The study was not funded.

Competing interests

The authors have declared that no competing interests exist.

Ethical approval

Ethical approval was obtained from the Institutional Review Board of Nagasaki University (reference number 18082019). This study conformed to the tenets of the Declaration of Helsinki.

Patient consent

Not required owing to the study’s retrospective nature.

References (21)

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