Abstract
ObjectiveTo systematically review the evidence to evaluate oncologic outcomes for patients with early stage buccal squamous cell carcinoma treated with surgery versus surgery and adjuvant radiation therapy.Data sourcesOvid MedLine, EMBASE, Google Scholar, PubMed.Review methodsThe primary purpose was to perform a systematic review to determine the published literature comparing oncologic outcomes of patients with early stage (Stages I&II) buccal mucosal squamous cell carcinoma, treated with surgical resection alone versus surgery plus adjuvant radiation therapy. Oncologic outcomes of interest were overall survival, locoregional recurrence, and disease specific survival. The secondary aim was to perform a meta-analysis to quantitively compare and summarize the data on oncologic outcomes between treatments.ResultsA total of 1457 studies were screened and five retrospective cohort studies (n = 733 patients) were eligible for quantitative analysis. Overall study quality was moderate to high. Pooled relative risk ratios using a fixed effects model did not reveal any statistically significant difference in overall survival (p = 0.70) or locoregional recurrence rates (p = 0.72) in Stage I and II disease.ConclusionsThese results demonstrate there is sparse evidence comparing oncologic outcomes for early stage buccal squamous cell carcinoma treated with surgery alone versus surgery and adjuvant radiation therapy. Our findings based on a limited body of evidence suggest no obvious benefit in the addition of adjuvant radiation therapy, however robust randomized trials are warranted to reach firm conclusions.
Highlights
IntroductionA aggressive form of Oral cavity cancer (OCCA) is squamous cell carcinoma (SCC) of the buccal mucosa
Oral cavity cancer (OCCA) is a prevalent form of head and neck cancer
Pooled relative risk ratios using a fixed effects model did not reveal any statistically significant difference in overall survival (p = 0.70) or locoregional recurrence rates (p = 0.72) in Stage I and II disease. These results demonstrate there is sparse evidence comparing oncologic outcomes for early stage buccal squamous cell carcinoma treated with surgery alone versus surgery and adjuvant radiation therapy
Summary
A aggressive form of OCCA is squamous cell carcinoma (SCC) of the buccal mucosa. The incidence of buccal SCC varies globally; it accounts for the majority of oral cancers in places such as India and South America, but only 10% of all oral cavity cancer in North America and Western Europe [2, 3]. This variation may be reflective of the common risk factors, as incidence is higher in areas where chewing tobacco and betel nut chewing are common [4]. Potential rationale for recurrence includes the intrinsically aggressive nature of the disease, and the lack of clear tissue planes within the buccal mucosa, making adequate surgical margin control difficult [8]
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