Abstract
BackgroundThe prognosis of advanced oral cancer remains dismal. While multimodal therapy is beneficial, maintaining the quality of life of long-term survivors is important. Therefore, risk-adapted treatment regimens need to be designed. We herein investigated whether pathological responses in oral cancer patients treated with preoperative chemoradiotherapy predict locoregional recurrence.MethodsWe retrospectively reviewed the data of 51 oral cancer patients who received preoperative radiotherapy and concurrent pepleomycin, followed by curative surgery at our institution between January 2009 and June 2018. Each patient received preoperative external beam irradiation to the primary tumor and lymphatics (2 Gy per day for approximately 3 weeks) concurrent with pepleomycin (2.5 mg/day). Surgery was performed approximately 3–4 weeks after the completion of preoperative chemoradiotherapy. Pathological responses were defined based on the grading system of Oboshi and Shimosato.ResultsEight, 22, 16, and 5 patients had Oboshi and Shimosato grades 2a, 2b, 3, and 4, respectively. Favorable pathological responses (grades 3 and 4) were observed in 41.2% of patients (21 out of 51 patients). The pathological response and number of pathological lymph node metastases were identified as significant prognostic factors for locoregional control in the univariate analysis. Three-year locoregional control rates were 100 and 56.6% in patients with favorable and unfavorable pathological responses, respectively.ConclusionsThe present study demonstrated that pathological tumor responses to preoperative chemoradiotherapy are a useful predictive factor for locoregional control.
Highlights
The prognosis of advanced oral cancer remains dismal
We investigated whether pathological responses in oral cancer patients treated with preoperative chemoradiotherapy predict locoregional recurrence
Surgery was performed within 4 weeks of preoperative chemoradiotherapy in 94.1% of patients (48 out of 51)
Summary
The prognosis of advanced oral cancer remains dismal. While multimodal therapy is beneficial, maintaining the quality of life of long-term survivors is important. Since the treatment outcomes of head and neck cancer are improved by multidisciplinary therapy, efforts to maintain the quality of life (QOL) of long-term survivors are crucial. Adjuvant radiotherapy after surgery for head and neck cancer is associated with late adverse events, including xerostomia and dysphagia, which deteriorate QOL [4]. Less intensive therapy, such as lower-dose irradiation, may increase the risk of recurrence, and oral cancer patients with recurrence, regardless of an initially early stage, have a poor prognosis [7]. The difficulties associated with the selection of initial treatment strategies, adjuvant radiotherapy and less or more intensive treatments, are attributed to the challenges of maintaining the balance between the preservation of function and cosmesis and locoregional control in head and neck cancer. The identification of prognostic factors is crucial for predicting the prognosis of each patient and selecting appropriate optimal therapy
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