Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma

Abstract

BACKGROUND: There are major variations between institutions regarding postoperative adjuvant therapy for adverse features in patients with oral squamous cell carcinoma (SCC). The authors' practice has been to not recommend any adjuvant therapy on the basis of close (<5 mm but uninvolved) margins unless there are additional adverse features. The primary objective of this study was to assess whether the local control achieved in this patient cohort was acceptable. METHODS: In this single-institution, retrospective analysis, local control was the primary endpoint, and disease-specific survival (DSS) was the secondary endpoint. Differences in survival were determined using the log-rank test, and survival curves were generated using the Kaplan-Meier method. RESULTS: One hundred forty-four patients (79 men and 65 women; median age, 64.1 years; mean follow-up, 3.3 years) underwent surgery alone for oral SCC with curative intent and were recorded as having close tumor margins on histology. The local control rate for all patients who underwent surgery alone was 91% (95% confidence interval, 81.9%-95.2%), and the DSS rate was 84% (95% confidence interval, 74.0%-89.9%) at 5 years. There was no pattern of worse local control or DSS rates with the ordered stratification of close margins. The 5-year local control rates for having 0, 1, 2, and 3 additional adverse features were 100%, 96%, 83%, and 71%, respectively (P 5.004; trend test). CONCLUSIONS: Surgery alone without postoperative adjuvant therapy offered acceptable local control in patients who had close margin status as their only adverse feature and may be reasonable in the presence of 1 other adverse clinicopathologic feature.

Adverse pathologic features in T1/2 oral squamous cell carcinoma classified by the American Joint Committee on Cancer eighth edition and implications for treatment

“…29,33 Figure 3 shows the stratification of the cumulative effect of each of the adverse features. It also identifies the better prognostic group resulting in a better estimated 5-year survival.…”

A retrospective analysis to determine factors contributing to the survival of patients with oral squamous cell carcinoma

“…A study done by Ch'ng et al demonstrated that patients who had close surgical margins show acceptable local control without post-operative adjuvant therapy [21]. However, even the margins which are apparently histologically free of tumour, may demonstrate molecular changes at the margins which could account for recurrence.…”

Close Margins in Oral Cancers: Implication of Close Margin Status in Recurrence and Survival of pT1N0 and pT2N0 Oral Cancers

“…Wong et al [30] suggested that surgical margins within 2 mm should be considered the cut-off for recommendation of PORT. Ch'ng et al [31] also have concluded that patients with close margins had acceptable local control without PORT in the absence of other risk factors.…”