Poster 08: Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Tongue

Abstract

Statement of the ProblemOral cancer accounts for 274,000 new cases worldwide annually, representing approximately 2.6% of all newly diagnosed cancers. Despite recent advances in surgery, radiotherapy, and chemotherapy, the 5-year survival rate for this disease has not improved significantly over the past several decades. Reported rates of oral cancer recurrence range from 25% to 48%. Improving the treatment outcome for these cases would lead to a better prognosis of oral cancer. However, salvage therapy is one of the critical challenges to improve outcome. The aim of this study is to evaluate the prognostic factor and the outcome for salvage surgery in patients with recurrent oral tongue squamous cell carcinoma (OTSCC).Materials and MethodsWe reviewed the medical records of patients who were referred to Aichi Cancer Center, Nagoya, Japan to treat their recurrent OTSCC after definitive radiotherapy or radical surgery. Out of the group, we enrolled those who had undergone salvage surgery for their recurrent OTSCC between March 1985 and March 2000 in the current study. There were 69 patients available to collect demographic data, details of salvage surgery, clinical course, and survival data.Methods of Data AnalysisA Cox proportional-hazards regression analysis was used to identify the multivariate predictive value of prognostic factors. Differences in overall survival between groups of patients were assessed by log-rank test and survival curves were constructed using the Kaplan-Meier method.Results of InvestigationForty patients (58%) were males and 29 patients (42%) were females, with ages ranging from 24.1 to 81.6 years. Forty-seven patients (68%) received definitive radiotherapy as their initial treatment, whereas 22 (32%) underwent radical surgery with or without radiotherapy. rT classifications were: rT0 in 30 patients (43%), rT1 in 13 (19%), rT2 in 14 (20%), rT3 in 1 (1%), and rT4 in 8 (12%). rN classifications were: rN0 in 26 patients (38%), rN1 in 18 (26%), rN2a in 9 (13%), rN2b in 11 (16%), and rN2c in 2 (3%). Thirty-seven patients (54%) underwent salvage surgery for the local recurrences. Ten patients (14%) underwent the selective neck dissection for rN-lesions whereas 43 (62%) underwent the radical neck dissection as therapeutic intent for rN+ lesions. The univariate analysis showed that the stage of recurrent tumors, the total number of positive cervical lymph node (CLN), the level of positive CLN, the extracapsular spread (ECS), and the recurrent interval after initial treatments had significant impact on survival after salvage surgery. Moreover, the multivariate analysis identified that ECS was an independent prognostic factor for survival. The 5-year overall survival rate for patients with stage I, II recurrent tumors (86.4%) was significantly higher than that for patients with stage III, IV recurrent tumors (47.7%; P < .05). Patients with ECS at their salvage surgery showed a lower 5-year overall survival rate (37.0%) than patients without ECS (76.9%; P < .05). Patients who had a recurrence within 12 months from initial treatment had a significantly poorer survival compared with patients who had a recurrence after 12 months.ConclusionOur study showed that ECS was a significant factor in survival. The total number and the level of positive CLN at the salvage surgery and the recurrent interval from initial treatment also influenced survival. Statement of the ProblemOral cancer accounts for 274,000 new cases worldwide annually, representing approximately 2.6% of all newly diagnosed cancers. Despite recent advances in surgery, radiotherapy, and chemotherapy, the 5-year survival rate for this disease has not improved significantly over the past several decades. Reported rates of oral cancer recurrence range from 25% to 48%. Improving the treatment outcome for these cases would lead to a better prognosis of oral cancer. However, salvage therapy is one of the critical challenges to improve outcome. The aim of this study is to evaluate the prognostic factor and the outcome for salvage surgery in patients with recurrent oral tongue squamous cell carcinoma (OTSCC). Oral cancer accounts for 274,000 new cases worldwide annually, representing approximately 2.6% of all newly diagnosed cancers. Despite recent advances in surgery, radiotherapy, and chemotherapy, the 5-year survival rate for this disease has not improved significantly over the past several decades. Reported rates of oral cancer recurrence range from 25% to 48%. Improving the treatment outcome for these cases would lead to a better prognosis of oral cancer. However, salvage therapy is one of the critical challenges to improve outcome. The aim of this study is to evaluate the prognostic factor and the outcome for salvage surgery in patients with recurrent oral tongue squamous cell carcinoma (OTSCC). Materials and MethodsWe reviewed the medical records of patients who were referred to Aichi Cancer Center, Nagoya, Japan to treat their recurrent OTSCC after definitive radiotherapy or radical surgery. Out of the group, we enrolled those who had undergone salvage surgery for their recurrent OTSCC between March 1985 and March 2000 in the current study. There were 69 patients available to collect demographic data, details of salvage surgery, clinical course, and survival data. We reviewed the medical records of patients who were referred to Aichi Cancer Center, Nagoya, Japan to treat their recurrent OTSCC after definitive radiotherapy or radical surgery. Out of the group, we enrolled those who had undergone salvage surgery for their recurrent OTSCC between March 1985 and March 2000 in the current study. There were 69 patients available to collect demographic data, details of salvage surgery, clinical course, and survival data. Methods of Data AnalysisA Cox proportional-hazards regression analysis was used to identify the multivariate predictive value of prognostic factors. Differences in overall survival between groups of patients were assessed by log-rank test and survival curves were constructed using the Kaplan-Meier method. A Cox proportional-hazards regression analysis was used to identify the multivariate predictive value of prognostic factors. Differences in overall survival between groups of patients were assessed by log-rank test and survival curves were constructed using the Kaplan-Meier method. Results of InvestigationForty patients (58%) were males and 29 patients (42%) were females, with ages ranging from 24.1 to 81.6 years. Forty-seven patients (68%) received definitive radiotherapy as their initial treatment, whereas 22 (32%) underwent radical surgery with or without radiotherapy. rT classifications were: rT0 in 30 patients (43%), rT1 in 13 (19%), rT2 in 14 (20%), rT3 in 1 (1%), and rT4 in 8 (12%). rN classifications were: rN0 in 26 patients (38%), rN1 in 18 (26%), rN2a in 9 (13%), rN2b in 11 (16%), and rN2c in 2 (3%). Thirty-seven patients (54%) underwent salvage surgery for the local recurrences. Ten patients (14%) underwent the selective neck dissection for rN-lesions whereas 43 (62%) underwent the radical neck dissection as therapeutic intent for rN+ lesions. The univariate analysis showed that the stage of recurrent tumors, the total number of positive cervical lymph node (CLN), the level of positive CLN, the extracapsular spread (ECS), and the recurrent interval after initial treatments had significant impact on survival after salvage surgery. Moreover, the multivariate analysis identified that ECS was an independent prognostic factor for survival. The 5-year overall survival rate for patients with stage I, II recurrent tumors (86.4%) was significantly higher than that for patients with stage III, IV recurrent tumors (47.7%; P < .05). Patients with ECS at their salvage surgery showed a lower 5-year overall survival rate (37.0%) than patients without ECS (76.9%; P < .05). Patients who had a recurrence within 12 months from initial treatment had a significantly poorer survival compared with patients who had a recurrence after 12 months. Forty patients (58%) were males and 29 patients (42%) were females, with ages ranging from 24.1 to 81.6 years. Forty-seven patients (68%) received definitive radiotherapy as their initial treatment, whereas 22 (32%) underwent radical surgery with or without radiotherapy. rT classifications were: rT0 in 30 patients (43%), rT1 in 13 (19%), rT2 in 14 (20%), rT3 in 1 (1%), and rT4 in 8 (12%). rN classifications were: rN0 in 26 patients (38%), rN1 in 18 (26%), rN2a in 9 (13%), rN2b in 11 (16%), and rN2c in 2 (3%). Thirty-seven patients (54%) underwent salvage surgery for the local recurrences. Ten patients (14%) underwent the selective neck dissection for rN-lesions whereas 43 (62%) underwent the radical neck dissection as therapeutic intent for rN+ lesions. The univariate analysis showed that the stage of recurrent tumors, the total number of positive cervical lymph node (CLN), the level of positive CLN, the extracapsular spread (ECS), and the recurrent interval after initial treatments had significant impact on survival after salvage surgery. Moreover, the multivariate analysis identified that ECS was an independent prognostic factor for survival. The 5-year overall survival rate for patients with stage I, II recurrent tumors (86.4%) was significantly higher than that for patients with stage III, IV recurrent tumors (47.7%; P < .05). Patients with ECS at their salvage surgery showed a lower 5-year overall survival rate (37.0%) than patients without ECS (76.9%; P < .05). Patients who had a recurrence within 12 months from initial treatment had a significantly poorer survival compared with patients who had a recurrence after 12 months. ConclusionOur study showed that ECS was a significant factor in survival. The total number and the level of positive CLN at the salvage surgery and the recurrent interval from initial treatment also influenced survival. Our study showed that ECS was a significant factor in survival. The total number and the level of positive CLN at the salvage surgery and the recurrent interval from initial treatment also influenced survival.