Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration.

Jillian Tsai,Howard Liu ,Brandon Prendes ,David J. Adelstein,Jamie Ku ,Ahmed I Ghanem ,Nancy Lee,N.m. Woody ,Shlomo A. Koyfman,J.l. Geiger ,Nikhil Joshi ,L. Schwartzman ,Eric Lamarre ,Arslan Babar,Matthew Schymick,Neal E. Dunlap,Jimmy J. Caudell,Sandro Porceddu ,Joseph Scharpf,Farzan Siddiqui,Brian B. Burkey

doi:10.3390/curroncol28040221

Abstract

Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.

Highlights

In 2004, two randomized controlled trials, Radiation Therapy Oncology Group (RTOG) 9501 and European Organization for Research and Treatment of Cancer (EORTC) 22931, reported improved outcomes when chemotherapy was added to post-operative radiotherapy (PORT) in high-risk resected head and neck squamous cell carcinoma (HNSCC) [1,2,3]
From a total sample size of 1282 oral cavity squamous cell carcinoma (OCSCC) patients, we identified 196 (15.3%) patients with high-risk features who were treated with concurrent chemoradiation (CRT) with cisplatin or cetuximab (Figure 1)
High-dose cisplatin added to adjuvant RT is the standard chemotherapy for highrisk resected OCSCC, with a benefit in survival outcomes compared with adjuvant RT alone [1,3,4]

Summary

Introduction

In 2004, two randomized controlled trials, Radiation Therapy Oncology Group (RTOG) 9501 and European Organization for Research and Treatment of Cancer (EORTC) 22931, reported improved outcomes when chemotherapy was added to post-operative radiotherapy (PORT) in high-risk resected head and neck squamous cell carcinoma (HNSCC) [1,2,3]. A combined analysis demonstrated patients with high-risk features, defined as either positive surgical margins (SM+) or extracapsular extension (ENE), benefitted the most from the addition of cisplatin [4]. These results established the standard of care treatment for resected high-risk HNSCC with high-dose cisplatin (100 mg/m2) every three weeks, administered concurrently with radiation (RT) [5]. Low-dose cisplatin at 6 mg/m2 with RT has been found feasible [14] All of these regimens are administered concurrently with RT and are used in both post-operative and definitive settings

Methods

Results

Discussion

Conclusion