Non-operative management for oral cavity carcinoma: Definitive radiation therapy as a potential alternative treatment approach

Hosni, Ali; Chiu, Ka Lok; Huang, Shao Hui; Xu, Wei; Huang, Jingyue; Bayley, Andrew; Bratman, Scott V.; Cho, John; Giuliani, Meredith; Kim, John; Ringash, Jolie; Waldron, John; Spreafico, Anna; Almeida, John R. de; Monteiro, Eric; Witterick, Ian J.; Gilbert, Ralph W.; Irish, Jonathan C.; Goldstein, David P.; Hope, Andrew

doi:10.1016/j.radonc.2020.08.013

Cited by 31 publications

(29 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the results suggest a potential effect of dose escalation on local control. The acute radiation toxicity in the cohort was comparable to the results reported in other published studies [ 7 , 17 , 18 , 22 ] using different radiotherapy techniques and doses. No acute CTCAE grade 4 toxicity manifested.…”

Section: Discussionsupporting

confidence: 86%

“…This is comparable to the results of studies with different dose-escalation techniques [ 12 , 26 , 27 ]. Hosni et al [ 7 ] published the results for 108 patients with T1–T4 stage oral cavity tumors treated with definitive radiochemotherapy; after a median follow-up of 52 months, osteonecrosis developed in 6.6% of the patients. Foster et al [ 28 ] reported the incidence of osteonecrosis and long-term feeding tube dependence in 20.7% and 10% of patients after definitive radiochemotherapy in 140 patients with oral cavity cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The local control rate in our cohort at 2 and 5-years was 70% and 62%, respectively. Compared to other published studies, Hosni et al [ 7 ] recently reported the results for 108 patients with oral cavity tumors treated with definitive chemoradiotherapy. The 2-year local control rate was 80%.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Though surgical resection is an effective and preferred modality in early stages, [ 3 – 5 ] treatment of advanced tumors requires a complex approach based on a combination of surgery and radiotherapy [ 6 – 9 ]. For patients who are considered beyond cure and surgery is not feasible, definitive radiochemotherapy is the preferred option [ 4 , 7 ]. However, locoregional failure is the predominant pattern of failure in these patients [ 10 ], and the majority of local failures are identified in high-dose areas of modern radiochemotherapy due to the presence of a subpopulation of cells resistant to the standard radiation dose.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

et al. 2021

View full text Add to dashboard Cite

Purpose We evaluated the efficiency and toxicity of stereotactic hypofractionated boost in combination with conventionally fractionated radiotherapy in the treatment of advanced floor of the mouth cancer. Methods Thirty-seven patients with advanced stage of the floor of the mouth cancer, histologically confirmed squamous cell carcinoma (p16 negative) ineligible for surgical treatment, were indicated for radiochemotherapy or hyperfractionated accelerated radiotherapy (HART). The radiotherapy protocol combined external beam radiotherapy (EBRT) and a stereotactic hypofractionated boost to the primary tumor. The dose delivered from EBRT was 70–72.5 Gy in 35/50 fractions. The hypofractionated boost followed with 10 Gy in two fractions. For the variables—tumor volume, stage and grade a multivariate analysis was performed to find the relationship between overall survival, local progression and metastasis. Toxicity was evaluated according to CTCAE scale version 4. Results After a median follow-up of 16 months, 23 patients (62%) achieved complete remission. The median time to local progression and metastasis was 7 months. Local control (LC) at 2 and 5-years was 70% and 62%, respectively. Progression-free survival (PFS) and overall survival (OS) were 57% and 49% at 2 years and 41% and 27% at 5 years, respectively. Statistical analysis revealed that larger tumors had worse overall survival and a greater chance of metastasis. Log-Rank GTV > 44 ccm (HR = 1.96; [95% CI (0.87; 4.38)]; p = 0.11). No boost-related severe acute toxicity was observed. Late osteonecrosis was observed in 3 patients (8%). Conclusion The combination of EBRT and stereotactic hypofractionated boost is safe and seems to be an effective option for dose escalation in patients with advanced floor of the mouth tumors who are ineligible for surgical treatment and require a non-invasive approach.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, the presented cohort offers certain peculiarities that should be respected concerning treatment planning. Although primary radiotherapy is a valuable option for radiation-naive patients suffering from head and neck cancer that offers good local and regional control rates, there are advantages of a primary surgical approach that should be considered [ 13 ]. These include the possibility to further improve the outcome if complete tumor resection is achieved, to guide adjuvant therapy by possibly detecting occult lymph node metastases, and to restore areas where extensive tumor growth may lead to defect healing if primary radiotherapy is applied.…”

Section: Discussionmentioning

confidence: 99%

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Moratin

Mrosek

Horn

et al. 2021

Cancers

View full text Add to dashboard Cite

Advanced tumors of the head and neck are challenging for the treatment specialist due to the need to synergize oncological and functional requirements. Free flap reconstruction has been established as the standard of care for defects following tumor resection. However, depending on the affected anatomic subsite, advanced tumors may impose specific difficulties regarding reconstruction, especially when full-thickness resection is required. This study aimed to evaluate reconstructive strategies and oncological outcomes in patients with full-thickness resection of the oral cavity. A total of 33 patients with extensive defects due to squamous cell carcinoma of the oral cavity were identified. Indications, reconstructive procedures, and clinical outcome were evaluated. Thirty-two patients (97%) presented locally advanced tumors (T3/T4). Complete tumor resection was achieved in 26 patients (78.8%). The anterolateral thigh flap was the most frequently used flap (47.1%), and the primary flap success rate was 84.8%. The cohort demonstrated a good local control rate and moderate overall and progression-free survival rates. Most patients regained full competence regarding oral alimentation and speech. Full-thickness tumor resections of the head and neck area may be necessary due to advanced tumors in critical anatomic areas. In many cases, radical surgical treatment leads to good oncological results. Free flap reconstruction has been shown to be a suitable option for extensive defects in aesthetically challenging regions.

show abstract

Outcomes of primary radiotherapy with or without chemotherapy for advanced oral cavity squamous cell carcinoma: Systematic review

et al. 2021

View full text Add to dashboard Cite

Background Surgery with adjuvant radiotherapy is the accepted standard for treatment of advanced oral cavity squamous cell carcinoma (OCSCC); however, alternative evidence suggests that definitive (chemo)radiotherapy may have similar outcomes. Methods Systematic review was performed to assess the therapeutic value of radiotherapy or chemoradiotherapy as a primary modality for treating OCSCC. Meta‐analysis of outcomes was performed between articles comparing radiotherapy and primary surgical treatment. Results Meta‐analysis showed less favorable results of radiotherapy compared to surgery: overall survival at 3‐years (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.34–0.77) and 5‐years (OR = 0.42; 95% CI = 0.29–0.60); disease‐specific survival at 3‐years (OR = 0.55; 95% CI = 0.32–0.96) and 5‐years (OR = 0.55; 95% CI = 0.32–0.96). Odds of feeding tube dependency were higher in primary radiotherapy group (OR = 2.67; 95% CI = 1.27–5.64). Conclusions Results of this study support the current perspective favoring primary surgical treatment for OCSCC in the absence of surgical contraindications.

show abstract

Non-operative management for oral cavity carcinoma: Definitive radiation therapy as a potential alternative treatment approach

Abstract: Highlights: Definitive RT/CRT for OSCC achieved acceptable rate of locoregional control. Definitive RT is a reasonable alternative treatment strategy if surgery is not possible. cN2-3 is associated with poor distant control, DFS, and OS.

Cited by 31 publications

References 40 publications

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Outcomes of primary radiotherapy with or without chemotherapy for advanced oral cavity squamous cell carcinoma: Systematic review

Contact Info

Product

Resources

About