Treatment Results of T4a and T4b Oral Cavity Cancer

Abstract

To evaluate the treatment results and outcome of T4a and T4b oral squamous cell carcinoma (OSCC) at a single institution. METHODS: The charts of 251 consecutively untreated T4 OSCC patients (reclassified by AJCC 2002) eligible for treatment (surgery plus RT, exclusive RT, RT plus QT) were retrospectively analyzed. Factors with possible impact on survival were analysed. Survival rates were calculated according to the Kaplan-Meier method. RESULTS: 196 patients were classified T4a and 55 as T4b. 49% percent of patients underwent radical surgery plus RT, 30.6% received RTϩ/-CT and 17.2% had palliative RT. The 5-year disease-free (DFS) and overall (OS) survival rates for those who had surgery plus RT were 49.5% and 42.5%, respectively, in comparison with 30.4% and 37.3% for patients undergoing RTϩ/-CT, respectively. Univariate analysis revealed that age, N-stage, and type of treatment (pϭ.003, pϭ.006, and pϽ.001, respectively) were predictors for local control in T4a and T4b patients. In multivariate analysis, type of treatment was independent predictor for DFS and OS (pϭ.0001, and pϭ.0001, respectively). CONCLUSIONS: Radical surgery plus radiotherapy was shown to be the best therapeutic option for T4a OSCC patients. This study also emphasized the role of TNM classification as a reliable prognostic indicator.