No difference in disease-free survival after oral cancer resection with close tumor margins in patients with and without postoperative radiotherapy

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From: Ear, Nose and Throat Journal(Vol. 97, Issue 9)
Publisher: Sage Publications, Inc.
Document Type: Report
Length: 3,465 words
Lexile Measure: 1630L

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Abstract

We conducted a retrospective follow-up study to determine if adjunctive radiotherapy (RT) affected disease-free survival in patients with oral squamous cell carcinoma (SCC) who were found to have close surgical margins after tumor resection. Our study population was made up of 110 patients - 72 men and 38 women, aged 30 to 94 years (median: 66) at the time of diagnosis. Their follow-up ranged from 12 days to 5.2 years (median: 3.6 yr). Of this group, 40 patients had free margins, 55 patients had close margins, and 15 had involved margins after surgery. Only 31 of these patients received postoperative RT, including 17 who had close margins. We would expect to find better postoperative local tumor control with combined surgery and RT, but we found no statistically significant difference in disease-free survival between the surgery-plus-RT group and the surgery-only group (p = 0.72). We also found no significant difference in disease-free survival between patients with a tumor of the floor of mouth and those with a tumor of the tongue (p = 0.34). In the study population as a whole, the disease-free survival rate was 81.0% and the overall survival rate was 78.2%. Our findings support the trend toward a watch-and-wait approach before initiating postoperative RT for patients with close surgical margins. The decision should be carefully discussed between the surgeon, the oncologic radiotherapist, and the patient.

Introduction

The choice of treatment for oral squamous cell carcinoma (SCC) according to the Danish Head and Neck Cancer Group (DAHANCA) guidelines depends on tumor stage and histopathologic factors. Surgery is the preferred monotherapy for patients with a low risk of recurrent disease (T1/2N0M0), while a combination of surgery and either radiotherapy (RT) or chemoradiotherapy is recommended for high-risk patients.

Successful treatment with radical surgery demands a minimum macroscopic resection margin of 10 mm and a minimum microscopic margin of 5 mm to achieve free margins. (1) The width of the margin cited on the pathology report will often differ from the 10- and 5-mm margins that the surgeon intended. This can be attributable to several factors, such as the anatomy of the involved oral cavity, the shrinking of the tumor and surrounding tissue after removal, fixation of the tissue, and microscopic changes. (2-5) Involved margins demand additional treatment, but often there is a group of patients at intermediate risk for recurrent disease whose resection margins are 1 to 5 mm.

While there is general agreement on the type of treatment for patients at low and high risk for recurrence, there is controversy regarding the primary treatment for patients with close surgical margins, who are at intermediate risk, as studies have found different locoregional control and long-term survival rates after combined surgery and RT versus surgery alone. (6-8)

In 2012, a review by Brown et al found that both overall survival rates and disease-free survival rates were better in patients who were treated with combined therapy than in those treated only surgically (94 vs. 84%, no p value reported, and 68 vs....

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Gale Document Number: GALE|A558921698