Postoperative Irradiation with or without Concomitant Chemotherapy for Locally Advanced Head and Neck Cancer

Bernier, Jacques; Domenge, C.; Ozşahin, Mahmut; Matuszewska, Katarzyna; Lefèbvre, Jean Louis; Greiner, Richard; Giralt, Jordi; Maingon, P.; Rolland, Frédéric; Bolla, M.; Cognetti, F.; Bourhis, Jean; Kirkpatrick, A.; Glabbeke, M. van

doi:10.1056/nejmoa032641

Cited by 2,798 publications

(2,267 citation statements)

References 37 publications

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“…The efficacy of NAC is controversial, as described above, and no report supports NAC with a high evidence level. Accordingly, at present, the standard treatment of oral cancers is surgery alone, and radiotherapy or concomitant chemoradiotherapy after surgery is recommended for high-risk cases in which recurrence or metastasis is expected [12,37,38]. In our study, NAC increased the local recurrence rate over that in patients without NAC.…”

Section: Discussionmentioning

confidence: 47%

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate.The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3% (6/58 patients) and 15.5% (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7%, which was significantly lower than that (96.2%) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone.

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Section: Discussionmentioning

confidence: 47%

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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“…A relatively recent, prospective, randomized controlled trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) suggested that intensification of therapy, not only with PORT but also with concomitant chemotherapy, is warranted with a margin <5 mm in head and neck SCC, including SCC of the oral cavity. 1,3 Another trial conducted in parallel by the US Radiation Therapy Oncology Group (RTOG) supported the role of CERT for high-risk margins, which, however, was defined as tumor at the resected margin. 2 Note that, in addition to margin status, the EORTC trial defined high risk as extracapsular extension (ECE) of lymph node disease, clinical involvement of lymph nodes There was a strong association between the number of adverse features and local control.…”

Section: Discussionmentioning

confidence: 99%

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

Ch’ng

Corbett-Burns

Stanton

et al. 2013

Cancer

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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.

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“…The prognostic significance of surgical margin for LR of head and neck cancer and oral tongue cancer has been reported [1,[14][15][16] and it was confirmed as a risk factor when \5 mm of margin status was encountered even though the patients had postoperative adjuvant therapy. Tumor thickness has been considered to correlate with cervical lymph node metastasis but there is no clear consensus of how to measure depth or thickness and also the decisive cut-off level for elective neck treatment.…”

Section: Discussionmentioning

confidence: 87%

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

Sittitrai

Srivanitchapoom

Mahanupab

et al. 2012

Indian J Otolaryngol Head Neck Surg

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To determine predictive factors which affect local and regional recurrence of T1-2N0-1M0 oral tongue carcinoma (OTC). Records of 42 patients with T1-2N0-1 M0 OTC were reviewed. The clinical characteristics, histopathological data, disease recurrence and survival rate were analyzed. Descriptive statistics and Kaplan-Meier survival analysis were used. The median follow up was 38 months. The 2-year overall survival and disease-free survival rates were 85.7 and 55.6 % respectively. At the 2 year analysis, there were surgical margin\5 mm (p value = 0.01), tumor thickness [7 mm (p value = 0.03), perivascular and perilymphatic invasion (p value = 0.01) affected on local recurrence and perivascular and perilymphatic invasion were also predictors for regional recurrence (p value = 0.04). The surgical margin status, tumor thickness, perivascular and perilymphatic invasion represented significant predictive factors for local recurrent OTC. Postoperative adjuvant therapy should be considered in these groups.

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Postoperative Irradiation with or without Concomitant Chemotherapy for Locally Advanced Head and Neck Cancer

Abstract: Postoperative concurrent administration of high-dose cisplatin with radiotherapy is more efficacious than radiotherapy alone in patients with locally advanced head and neck cancer and does not cause an undue number of late complications.

Cited by 2,798 publications

References 37 publications

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

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

Impact of Clinical and Histo-Pathological Prognostic Factors on T1-2N0-1 Oral Tongue Carcinoma

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