Impact of 3 mm margin on risk of recurrence and survival in oral cancer

Brinkman, David; Callanan, Deirdre; O’Shea, Ross; Jawad, Hadeel; Feeley, Linda; Sheahan, Patrick

doi:10.1016/j.oraloncology.2020.104883

Cited by 25 publications

(27 citation statements)

References 24 publications

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“…The general theory holds that tumors with "close" or positive margins carry an increased risk for local recurrence. 1,2 Several head and neck cancer studies have shown that margins greater than 5 mm confer a survival advantage and decrease in locoregional recurrence when compared to "close" or positive margins. [3][4][5][6][7][8][9] Specifically in the oropharynx, positive margins have been associated with higher rates of local recurrence although recent studies have challenged this paradigm in human papilloma virus (HPV)-mediated tumors.…”

Section: Introductionmentioning

confidence: 99%

“…The goal of the head and neck cancer surgeon is to completely resect tumor with a cuff of healthy tissue or margin. The general theory holds that tumors with “close” or positive margins carry an increased risk for local recurrence 1,2 . Several head and neck cancer studies have shown that margins greater than 5 mm confer a survival advantage and decrease in locoregional recurrence when compared to “close” or positive margins 3–9 .…”

Section: Introductionmentioning

confidence: 99%

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Surgical Margin Determination in the Era of HPV‐Positive Oropharyngeal Cancer

et al. 2021

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Objectives/Hypothesis: The goal of head and neck cancer surgery is the complete resection of tumor with a cuff of healthy tissue. A 5-mm margin is optimal but not always achievable in the oropharynx. We aimed to identify a consensus of definition and management of close margins for human papilloma virus (HPV)-associated oropharyngeal cancer without other risk factors.Study Design: Descriptive survey. Methods: A survey of the American Head and Neck Society (AHNS) was conducted to evaluate the abovementioned objectives by presenting hypothetical scenarios and asking questions regarding management.Results: One-hundred fifty-five AHNS members completed the survey (18% response rate). Close margins were defined as <5 mm, <3 mm, and <1 mm by 27.7%, 32.3%, and 32.3% of respondents. There was no significant difference in margin determination with experience level (P = .186). In an HPV-positive tumor with close margins, 51% chose postoperative observation. The remainder chose adjuvant radiation (22.6%), chemoradiation (1.9%), or re-excision of the wound bed (19.4%). There was no association between postoperative close margin management and experience level (P = .80). Conclusion:Heterogeneity exists in the definition and management of close margins in HPV-mediated oropharyngeal carcinoma (OPSCC). Establishing a standard regarding close margins in HPV-mediated OPSCC may allow for the optimization of outcomes and help define best practices.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Margin Determination in the Era of HPV‐Positive Oropharyngeal Cancer

et al. 2021

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“…Some authors have considered that millimetre distance – albeit with diverse interpretative ranges – is crucial for oncological outcomes 17-19 (among the most recent). Others, while confirming the importance of margins, also suggest that other factors affect prognosis 20 , 21 (among the most recent). There are also several authors who deny the prognostic significance of margins 22 , 23 (among the most recent), even in multivariate analyses 24 , 25 .…”

Section: Discussionmentioning

confidence: 79%

Multicentre study on resection margins in carcinoma of the oral cavity, oro-hypopharynx and larynx

Barzan

Montomoli

Carlo

et al. 2022

Acta Otorhinolaryngol Ital

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SUMMARY Objective The prognostic significance of the resection margins is still subject of conflicting opinions. The purpose of this paper is to report the results of a study on the margins in carcinoma of the oral cavity, oro-hypopharynx and larynx. Methods A multicentre prospective study was carried out between 2015 and 2018 with the participation of 10 Italian reference hospitals. The primary objective was to evaluate local control in patients with well-defined clinical characteristics and comprehensive histopathological information. Results During the study period, 455 patients were enrolled; the minimum follow-up was 2 years. Previous treatment, grading and fresh specimen examination were identified as risk factors for local control in multivariate analysis. On the basis of these results, it seems possible to delineate “risk profiles” for different oncological outcomes. Discussion The prognostic significance of the margins is reduced, and other risk factors emerge, which require diversified treatment and follow-up. Conclusions Multidisciplinary treatment with adjuvant therapy, if indicated, reduces the prognostic importance of margins. Collaboration with a pathologist is an additional favourable prognostic factor and quality indicator. An appendix with literature review is present in the online version.

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“…In this review, despite the aggressive approach to the tumor via the lip-splitting method with or without mandibulectomy in 92% of the study population, high positive surgical margin rates of 33% 12 , 20% 15 , and 57% 18 were reported. Many previous articles have demonstrated the significantly higher prevalence of positive margins in RMT tumors compared with those originating from other oral regions 3,[31][32][33][34][35] . The limited surgical excision and exposure 3,[32][33][34][35] due to confinement from adjacent anatomic structures and the invasive nature of carcinomas arising in that location 31 could explain that finding.…”

Section: Significant Findingsmentioning

confidence: 97%

“…Many previous articles have demonstrated the significantly higher prevalence of positive margins in RMT tumors compared with those originating from other oral regions 3,[31][32][33][34][35] . The limited surgical excision and exposure 3,[32][33][34][35] due to confinement from adjacent anatomic structures and the invasive nature of carcinomas arising in that location 31 could explain that finding.…”

Section: Significant Findingsmentioning

confidence: 97%

A systematic review of therapeutic outcomes following treatment of squamous cell carcinoma of the retromolar trigone

Kim

2021

JKAOMS

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Squamous cell carcinoma (SCC) of the retromolar trigone (RMT) is a rare but potentially fatal disease that carries a poor prognosis due to its unique anatomic position. RMT SCCs tend to spread to vital nearby structures, including the tonsillar pillar, masticatory muscles, and underlying mandibular bone, even in their early stages, and aggressive treatment is often warranted. This systematic review appraises and qualitatively analyzes all available literature regarding the survival outcomes and prognosis of RMT SCC. Four databases were searched to identify all eligible articles published since January 1980. Of the 1,248 studies, a total of 15 studies representing 4,838 cases met the inclusion criteria. The evaluated patients had a high rate of advanced tumor stage (T3 or T4: 61.4%), lymph node metastasis (38.8%), and mandibular bone invasion (24%) at the time of diagnosis. Aggressive surgical treatments such as lip-splitting (92%), segmental mandibulectomy (61.1%), radical neck dissection (44.1%), and reconstruction using free flaps (49.5%) was undertaken for 92% of the pooled patient population. The mean rates for local, regional, and systemic recurrence were 23.40%, 8.40%, and 8.50%, respectively. The mean 5-year overall survival rate was 38.90%. Osteonecrosis was noted in 11.6% of the 328 patients who received radiotherapy. In conclusion, RMT SCC is generally associated with high recurrence, low survival, and high postoperative complication rates. Early diagnosis and aggressive treatment are thus warranted. However, significant methodological problems hamper current knowledge. Future studies of this topic that use randomized or cohort designs are thus needed.

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Impact of 3 mm margin on risk of recurrence and survival in oral cancer

Cited by 25 publications

References 24 publications

Surgical Margin Determination in the Era of HPV‐Positive Oropharyngeal Cancer

Surgical Margin Determination in the Era of HPV‐Positive Oropharyngeal Cancer

Multicentre study on resection margins in carcinoma of the oral cavity, oro-hypopharynx and larynx

A systematic review of therapeutic outcomes following treatment of squamous cell carcinoma of the retromolar trigone

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