Neoadjuvant radiochemotherapy of oral cavity and oropharyngeal cancer: evaluation of tumor response by ct differs from histopathologic response assessment in a significant fraction of patients

Abstract

Background. Our aim was to compare and assess the predictive value of CT and histopathologic grading of tumor regression at primary tumor sites in patients with squamous cell carcinoma of the oral cavity and oropharynx after neoadjuvant (preoperative) radiochemotherapy (RCT).Methods. We investigated 55 patients with carcinomas of the oral cavity and oropharynx who underwent RCT before curative surgery. Two blinded observers measured RCT-induced reduction of tumor volume in pretherapeutic and posttherapeutic CT scans. Volume changes were compared with histopathologic findings obtained at surgery.Results. Histopathologic response evaluation revealed 31 complete remissions, 12 cases of partial response, and 12 nonresponders. We performed a logistic regression analysis to evaluate whether measured volume reduction could predict the

Preoperative radiochemotherapy and radical resection for stages II to IV oral and oropharyngeal cancer: grade of regression as crucial prognostic factor

“…Whether macroscopic changes of the tumour under RCT can be correlated with the response on the microscopic level has to be shown. In a recent study, we compared changes of tumour volume in CT scans before and 4 to 5 weeks after RCT with the pathohistological response (RG) and found that in a significant proportion of patients volume changes did not correlate with response 14 .…”

Outcome and Histopathologic Regression in Oral Squamous Cell Carcinoma after Preoperative Radiochemotherapy

“…However, assessment of tumor response, e.g., the discrimination between remaining tumor and edema or scar tissue, by clinical examination and radiologic studies is difficult and vital tumor cell nests may still be present [23,32]. Klug et al compared radiochemotherapy-reduced tumor volume measured by CT with histological finding obtained at surgery and found false prediction by CT in 34.5% of the patients [23].…”

“…Klug et al compared radiochemotherapy-reduced tumor volume measured by CT with histological finding obtained at surgery and found false prediction by CT in 34.5% of the patients [23]. Wanebo et al observed, among patients with 100% CT-based remission rates, complete histological response in only 66% and therefore recommended general surgical resection to maximize tumor control and survival [41].…”

Preoperative chemoradiotherapy in the management of oral cancer: A review

“…The goal is to reduce the degree of surgical intervention. However, recent studies (Kirita et al, 2001;Klug et al, 2004) show that the tumour does not always shrink concentrically under CRT and that vital tumour cell nests may still be present in the periphery. Comparison with non-invasive diagnostic procedures and the histopathological response is expected to provide information that will help the clinician to assess size reduction preoperatively.…”