Advanced Oral Cavity Squamous Cell Research Articles

Survival outcomes of patients with advanced oral cavity squamous cell carcinoma treated with multimodal therapy: a multi-institutional analysis.

BackgroundThe oral cavity is the most common site for head and neck squamous cell carcinoma. Treatment of advanced stage oral cavity squamous cell carcinoma (OCSCC) has classically involved surgical resection with postoperative adjuvant radiotherapy (S-RT).Despite this aggressive dual modality therapy, the disease outcomes have remained poor. The treatment options expanded in 2004 when two international trials showed the addition of postoperative chemotherapy to radiation improved outcomes. These trials were, however not oral cavity site specific.ObjectiveTo assess survival outcomes of advanced OCSCC treated by differing modalities. The primary goal was to determine if the addition of postoperative chemotherapy (S-CRT) improves survival compared to other treatment regimens.MethodsDemographic, pathologic, treatment, and survival data was obtained from patients diagnosed with OCSCC from 1998–2010 in Alberta, Canada. 222 patients were included in the final analysis from 895 OCSCC patients. Actuarial overall, disease-specific, disease-free, and metastasis-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by treatment.ResultsPatients receiving S-CRT had improved overall, disease-specific, disease-free, and metastasis-free survival compared to S-RT, CRT or RT(p < 0.05). Two and five year estimated overall survival was significantly higher in the S-CRT group at 77 and 58% (p < 0.05), versus S-RT with 55 and 40% rates(p < 0.05). Results were similar for disease-specific, disease-free, and metastasis free survival with S-CRT being favoured. Patients with extracapsular spread (ECS) treated with S-CRT versus S-RT had 55% survival advantage at 5 years (p < 0.05).ConclusionThis study shows that adding adjuvant chemotherapy to S-RT improves survival outcomes in advanced OCSCC, especially in patients with ECS.

Clinical and histological prognostic factors in locally advanced oral cavity cancers treated with primary surgery

The primary objective of this study was to determine the clinical and pathological prognostic factors in locally advanced oral cavity cancers treated by primary surgery. All patients treated by primary surgery with free-flap reconstruction for locally advanced oral cavity squamous cell carcinoma in our institution between 2000 and 2010 were included in this retrospective study. Overall, cause-specific and locoregional disease-free survivals were determined by Kaplan-Meier analyses. Clinical and histological prognostic factors were assessed by univariate (Log Rank tests) and multivariate (Cox models) analyses. A total of 149 patients (102 men and 47 women; mean age=61.3±12.1 years) were included in the study. Five-year overall, cause-specific and locoregional disease-free survivals were 55%, 68% and 71%, respectively. Age, comorbidity and tumour size (histological evaluation) were significantly correlated with overall survival (P<0.05). Age, tumour size, bone invasion and surgical margins were significantly correlated with locoregional disease-free survival (P<0.05). The main prognostic factors identified in this study were clinical (age and comorbidity) and histological (pathological tumour size, bone invasion and surgical margins).

Outcome and patterns of failure after postoperative intensity modulated radiotherapy for locally advanced or high-risk oral cavity squamous cell carcinoma

BackgroundTo determine the outcome and patterns of failure in oral cavity cancer (OCC) patients after postoperative intensity modulated radiotherapy (IMRT) with concomitant systemic therapy.MethodsAll patients with locally advanced (AJCC stage III/IV) or high-risk OCC (AJCC stage II) who underwent postoperative IMRT at our institution between December 2006 and July 2010 were retrospectively analyzed. The primary endpoint was locoregional recurrence-free survival (LRRFS). Secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), acute and late toxicities.ResultsOverall 53 patients were analyzed. Twenty-three patients (43%) underwent concomitant chemotherapy with cisplatin, two patients with carboplatin (4%) and four patients were treated with the monoclonal antibody cetuximab (8%).At a median follow-up of 2.3 (range, 1.1–4.6) years the 3-year LRRFS, DMFS and OS estimates were 79%, 90%, and 73% respectively. Twelve patients experienced a locoregional recurrence. Eight patients, 5 of which had both a flap reconstruction and extracapsular extension (ECE), showed an unusual multifocal pattern of recurrence. Ten locoregional recurrences occurred marginally or outside of the high-risk target volumes. Acute toxicity grades of 2 (27%) and 3 (66%) and late toxicity grades of 2 (34%) and 3 (11%) were observed.ConclusionLRRFS after postoperative IMRT is satisfying and toxicity is acceptable. The majority of locoregional recurrences occurred marginally or outside of the high-risk target volumes. Improvement of high-risk target volume definition especially in patients with flap reconstruction and ECE might transfer into better locoregional control.

Induction chemotherapy for organ preservation versus surgery for advanced oral cavity squamous cell carcinoma (OCSCC).

e16014 Background: The objective of the study is to evaluate the outcomes of an induction selection (IS) concurrent chemotherapy protocol versus primary surgical extirpation in advanced OCSCC. Methods: Retrospective quasi-experimental comparison of patients treated by IS versus surgery. The cohorts were matched based on pretreatment characteristics and compared in an intent-to-treat model.19 patients were accrued with resectable stage III/IV OCSCC without bone involvement between 2000-2002 into a phase II IS trial using 1 cycle of IS to select patients for definitive chemoradiation (CRT). Tumor response was evaluated 3-weeks post-infusion. Patients with &gt;50% response underwent concurrent CRT (70Gy; 35 fractions with concurrent cisplatin 100mg/m2 or carboplatin (AUC 6) every 3-weeks for 3 cycles). Those with &lt;50% underwent surgical treatment and radiation therapy. A comparison cohort of patients with primary surgical extirpation was selected from an OCSCC database from 1998-2009. The surgical cohort of 53 patients was identified based on comparable pretreatment variables to the IS cohort. There was no difference in age, gender, pre-treatment AJCC stage, T-class, N-class, smoking status, alcohol status, or subsite between the two cohorts. Results: Kaplan-Meier estimates demonstrated overall survival (OS) at 5-years was 32% in the IS group and 64% in the surgical cohort. Disease-specific survival (DSS) at 5-years was 46% in the IS group and 76% in the surgical cohort. Local-regional control (LRC) at 5-years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better OS, DSS and LRC (p=0.03, p=0.001 and p=0.0002 respectively) in the surgical cohort compared to the IS cohort. Conclusions: Primary surgical treatment showed significantly better OS, DSS and LRC compared to IS in this quasi-experimental designed comparison. These findings support surgery as the principal treatment for OCSCC.

Need for Prophylactic Contralateral Neck Irradiation in all Locally Advanced Oral Cavity Squamous Cell Carcinomas?

Need for Prophylactic Contralateral Neck Irradiation in all Locally Advanced Oral Cavity Squamous Cell Carcinomas?

Influence of Pathological Nodal Status and Maximal Standardized Uptake Value of the Primary Tumor and Regional Lymph Nodes on Treatment Plans in Patients With Advanced Oral Cavity Squamous Cell Carcinoma

A better understanding of the prognostic factors in oral cavity squamous cell carcinoma (OSCC) may optimize the therapeutic approach. In this study, we sought to investigate whether the combination of clinical information, pathologic results, and preoperative maximal standardized uptake value (SUVmax) at the primary tumor and regional lymph nodes might improve the prognostic stratification in this patient group. A total of 347 consecutive OSCC patients were investigated. All participants underwent fluorodeoxyglucose-positron emission tomography within 2 weeks before surgery and neck dissection. The duration of follow-up was at least 24 months in all surviving patients. The optimal cutoff values for SUVmax at the primary tumor (SUVtumor-max) and regional lymph nodes (SUVnodal-max) were selected according to the 5-year disease-free survival (DFS) rate. Independent prognosticators were identified by Cox regression analysis. In multivariate analysis, a cutoff SUVtumor-max of 8.6, a cutoff SUVnodal-max of 5.7, and the presence of pathologic lymph node metastases were found to be significant prognosticators for the 5-year DFS. A scoring system using these three prognostic factors was formulated to define distinct prognostic groups. The 5-year rates for patients with a score between 0 and 3 were as follows: neck control, 94%, 86%, 77%, 59% (p < 0.0001); distant metastases, 1%, 7%, 22%, 47% (p < 0.0001); disease-specific survival, 93%, 85%, 61%, 36%, respectively (p < 0.0001). Based on the study findings, the combined evaluation of pathologic node status and SUVmax at the primary tumor and regional lymph nodes may improve prognostic stratification in OSCC patients.

Interstitial brachytherapy as boost for locally advanced T4 head and neck cancer

Purpose Locally advanced squamous cell cancers of the head and neck (SCCHN) with bone and cartilage invasion (BCI) or those with soft-tissue invasion (STI) have been treated with resection followedup with chemoradiotherapy (CRT) or definitive CRT. However, locoregional recurrence remained a large component of treatment failure. High-dose-rate interstitial brachytherapy (BT) has been used for dose escalation to further prevent local relapse. This is a review of our experience. Methods and Materials T4N0-3M0 locally advanced oral cavity and oropharyngeal squamous cell carcinoma (SCCA) patients underwent definitive CRT or radiotherapy (RT) followedup with brachytherapy (BT). RT doses ranged from 45 to 50.4 Gy. The patients were reassessed at this dose and if response was inadequate, patients underwent BT. BT doses ranged from 24 to 30 Gy at 3–4 Gy per fraction BID with 6 h in between fractions. Concurrent chemotherapy was platinum based. Results Twenty patients were treated with CRT or RT alone followed by BT. Thirteen patients had STI and 7 had BCI; 14 patients were treated with CRT followed by BT; and 6 patients were treated with RT alone followed by BT. Five-year locoregional control was 61%. Five-year overall survival was 29%. When we excluded the patients treated with RT alone, 5-year overall survival was 36%. Nodal status was the only prognostic factor. Conclusions This study suggests CRT followedup with BT for patients with T4 locally advanced SCCHN of the oral cavity, and oropharynx is a feasible treatment option. In patients with poor response to CRT, BT may be used for dose escalation to increase locoregional control.

Intra-arterial chemoradiation for T3-4 oral cavity cancer: Treatment outcomes in comparison to oropharyngeal and hypopharyngeal carcinoma

BackgroundSurgery followed by radiotherapy is the standard of care for resectable locally advanced oral cavity squamous cell carcinoma (SCC). We report the treatment outcomes of patients with T3-T4 SCC of the oral cavity treated with chemoradiation, an alternative approach.Patients and methodsFrom a series of 240 patients with stage III-IV carcinoma of the upper aerodigestive tract who were treated consecutively according to the RADPLAT protocol, a subset analysis of 155 patients with T3-T4 SCC (Oral cavity SCC N = 22, oropharynx SCC N = 94 and hypopharynx SCC N = 39), was performed. The goal was to test the hypothesis that oral cavity SCC treated with chemoradiation has similar outcomes to the two comparison sites.ResultsWith a median follow-up of 58 months, local disease control was 69% and the overall survival was 37%. In comparison, local disease control for the oropharynx and hypopharynx groups was 86% and 79% respectively. The overall survival rate for the oropharyngeal and hypopharyngeal groups were 41% and 6% respectivelyConclusionPatients with locally advanced oral cavity cancer treated with the chemoradiation protocol RADPLAT have outcomes that are equal or better compared to patients with similar disease involving the oropharynx and hypopharynx

Comparison of approaches for oral cavity cancer resection: Lip-split versus visor flap

OBJECTIVETo compare lip‐split and visor flap approaches to the oral cavity in terms of morbidity, margins, and locoregional recurrence.DESIGN AND SETTINGRetrospective case series at the University of Washington, Seattle.METHODSSeventy patients undergoing resection of advanced (T4) anterior oral cavity squamous cell carcinoma requiring fibula reconstruction were grouped according to surgical access procedure performed (lip‐split [LS] or visor flap [VF]). Data on surgical morbidity, margin status, and outcomes were compared.RESULTSRecurrence rates and positive margins were similar for both groups. Rates of postoperative fistulae were 6.8% (LS) vs 0% (VF) and for oral incompetence 14.6% (LS) vs 6.9% (VF). Most of the fistulas (37.5%) were in irradiated patients. Neither group had any malunions.CONCLUSIONSThere is no significant difference in pathological margins or rates of local recurrence when using either the lip‐split or the visor approach. The lip‐split approach has a higher rate of postoperative fistula formation than the visor flap approach; fistula formation may be associated with previous irradiation.

Cell kinetics and response to primary intra–arterial chemotherapy in patients with advanced oral cavity tumors

The relationship was analyzed between cell kinetics, defined as 3H-thymidine labeling index (3H-TdR LI), and clinical responses for 35 previously untreated patients with locally advanced oral cavity squamous cell carcinomas. Patients were treated with three cycles of vincristine and bleomycin (VB) or of VB plus methotrexate (VBM), given by intra-arterial infusion followed by surgery. The objective clinical response rate was higher after VBM treatment than after VB, whereas overall clinical response rates were similar for patients with slowly or rapidly proliferating tumors. The probability of relapse-free survival at 4 yr and overall survival was significantly higher for patients with high 3H-TdR LI tumors given VBM than for those given VB. For patients with slowly proliferating tumors, there were no differences in relapse-free survival and overall survival between the two treatments. These data suggest that patients with rapidly proliferating tumors benefit from primary intensive chemotherapy treatment including methotrexate and that cell kinetics can be used to formulate rational clinical protocols for oral cavity cancers.

Complete remission of metastatic squamous carcinoma after cisplatinum chemotherapy without sustained control, following primary tumour control by californium-252 brachytherapy

The case report by Burnet and Blake (1989), “Sustained complete remission of Stage IV carcinoma of the cervix with cisplatinum, methotrexate and bleomycin chemotherapy”, was of great interest. We have found californium-252 (Cf-252) neutron brachytherapy (Cf-NT) to be highly effective for local control of bulky T4 squamous cell carcinoma of the tonsiloropharynx (Maruyama, 1984). Hence, we tested Cf-NT with adjuvant cisplatin-based chemotherapy for treatment of a case of advanced and metastatic oral cavity squamous cell cancer. Cisplatin plus 5-fluorouracil is an effective combination (Decker et al, 1983; Campbell et al, 1987; Toohill et al, 1987; Taylor et al, 1989), which we used.