Decreased Radiation Doses to Oral Cavity With Stick-out Tongue Position Comparing to Neutral Tongue Position in Patients Treated With Intensity Modulated Radiation Therapy for Head and Neck Cancer: Case Report

Abstract

Purpose/Objective(s): Locally advanced squamous cell carcinoma of the oral cavity (LA-OCSCC) is most often treated with surgery followed by post-operative radiation therapy (S+PORT). Consequently, the effectiveness of organ preservation with concurrent chemoradiation (CRT) remains unclear. Here, we assessed the differences in survival between surgery and organ preservation in patients with LA-OCSCC treated with S+PORT or CRT. Materials/Methods: Using the National Cancer Database, we identified 6,900 patients with LA-OCSCC treated with S+PORT (n Z 4809) or CRT (n Z 2901) between 2004 and 2012. We used clinical stage grouping III-IVA to identify LA-OCSCC patients in order to avoid biases due to pathological staging in the S+PORT cohort. We excluded patients with T4b or N3 disease to avoid biases due to unresectable disease. Factors associated with use of chemoradiation were estimated using logistic regression analysis. Survival (OS) was estimated using Kaplan Meier methods and Cox proportional models. Comparisons between S+PORT and CRT were made in the entire cohort as well as using a propensity matched cohort of 1,136 patients. Results: Median follow-up was 17.3m for CRT vs. 25.6m for S+PORT (P < .0001). Compared to patients treated with S+PORT, patients receiving chemoradiation were more likely to be older than 60y, treated before 2007, live within 10 miles of the treating facility, treated at a non-Academic centers, have higher comorbidities, have T3-T4 tumors and have N2 nodal disease. Compared to CRT, S+PORT was associated with improved survival in all patients (3y OS: 53.9% for S+PORT vs. 37.8% for CRT; P < .0001) and in the propensity matched cohort (3y OS: 51.8% for S+PORT vs. 39.3% for CRT; P < .0001). S+PORT was associated with improved survival for T3-T4 tumors (3y OS: 49.7% for S+PORT vs. 36.0% for CRT; P < .0001) but was not associated with improved survival for T1-T2 tumors (3y OS: 59.1% for S+PORT vs. 53.5% for CRT; P Z .15). On multivariate analysis, improved OS was associated with S+PORT (HR: 0.66, 95% CI 0.61-0.71, P < .0001), age greater than 60y, treatment in 2010 or after, lower comorbidity scores and cT1-T2 disease. Conclusion: Compared to chemoradiation, surgery and post-operative radiation therapy was associated with improved survival for locally advanced oral cavity cancers, especially in T3-T4 disease. These data support the use of surgery as the initial treatment modality for operable oral cavity cancers.