Comparative analysis of the efficacy of definitive chemoradiation therapy and surgery followed by adjuvant radiation therapy in advanced-stage oral tongue cancer.

Abstract

It is a retrospective analysis of the treatment outcomes of 211patients with stage III-IVA-B resectable OTSCC. The patients were divided into two groups depending on the treatment modality: 114patients received surgery followed by adjuvant RT or CRT (S-RT/CRT) group; the definitive CRT group consisted of 97patients. The five-year overall survival (OS) was 57.0% in S-RT/CRT group vs 20.4% in CRT group; the five-year disease-free survival (DFS) in S-RT/CRT group was 56.5% vs 15.5%, in the CRT group. Comparison of survival curves revealed statistically significant higher OS and DFS rates in patients of S-RT/CRT group as compared with those in CRT patients (hazard ratio= 0.33 (95% confidence interval 0.23-0.47), p< 0.001vs hazard ratio= 0.25 (95% confidence interval 0.17-0.37), p< 0.001). A multivariate analysis showed a statistically significant prognostic effect of the primary tumor extension cT4 (p= 0.004), cervical lymph node involvement cN2 (p< 0.001), cN3 (p= 0.04) and treatment modality (p< 0.001) on OS. There was also found a statistically significant prognostic effect of the primary tumor extension cT4 (p= 0.02), cervical lymph node involvement cN2 (p< 0.001) and treatment modality (p< 0.001) on DFS. 18 (15.8%) patients of S-RT/CRT group and 13 (13.4%) patients (p= 0.77) of CRT group developed mandibular osteoradionecrosis. Primary surgery with adjuvant RT or CRT in advanced-stage resectable OTSCC significantly increases five-year OS and DFS rates as compared to those after definitive CRT.