Preoperative radiochemotherapy in the treatment of advanced oral cancer: Outcome of 276 patients

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Summary

Introduction

The aim of this study was to review survival and locoregional control in patients with advanced oral and oropharyngeal squamous cell carcinoma treated by multimodal therapy with preoperative radiochemotherapy and radical surgery.

Methods

Included in this analysis are 276 consecutive patients with UICC disease stages III and IV (T2: 13.0%; T3: 16.7%; T4: 70.3%; N0: 29.7%; N1: 20.3%; N2: 45.3%; N3: 4.7%; stage III: 16.3%; stage IV: 83.7%). All patients received preoperative radiochemotherapy (50 Gy, Mitomycin and 5-Fluorouracil) and radical locoregional resection.

Results

Median surveillance period was 101.4 months (24–202 months). 5-year overall survival probability was 53.9%. 5-year local control probability was 70.2%.

Conclusion

These results underline the reliability of preoperative treatment of patients with oral and oropharyngeal cancer.

Introduction

Advanced oral and oropharyngeal cancer is regarded as a growing health problem and the prognosis remains relatively poor (Warnakulasuriya, 2005). It is widely accepted that patients with locoregionally advanced tumours (UICC (international union against cancer) disease stages III and IV) and resectable primary tumours benefit from combined treatment modalities with surgery, radiotherapy (RT) and chemotherapy (CT) (Mohr et al., 1994, McGurk et al., 2007, Preuss et al., 2007). Yet there is no consensus whether RT and CT should be administered before or after surgery (Seiwert et al., 2007). At our institution the preoperative approach has been the standard treatment regime since 1990 for all patients with squamous cell carcinoma (SCC) staged T2 or worse. We have published the treatment results of 222 consecutive patients in 2005 (Klug et al., 2005a). The current review continues this work but focuses on patients with disease stages III and IV with the intention of improving comparability with the existing literature.

Section snippets

Materials and methods

By December, 31, 2006 a minimum follow-up of 24 months had been reached for 276 consecutive patients who underwent multimodal therapy from January 1, 1990, to December 31, 2004.

Inclusion criteria were:

  • 1.

    UICC stage III and IV SCC of the oral cavity or oropharynx.

  • 2.

    Absence of distant metastases.

  • 3.

    Resectability of primary tumour according to anatomically defined criteria (infiltration of the skull base, of the internal carotid artery and of prevertebral fascia were defined as unresectable).

  • 4.

    Operability

Results

By December, 31, 2006 a minimum follow-up (see Table 1.) of 24 months was reached for 276 consecutive patients. Retrievable survival data of 271 patients showed 137 (49.6%) patients were alive and 134 (48.6%) deceased, including 18 (6.5%) early postoperative deaths. Recurrence occurred in 73 (26.4%) patients (for detailed distribution of type of recurrence see Table 4.). Overall 5-year survival probability was 53.9% (see Fig. 1) and overall 5-year locoregional control probability was 70.2% (see

Discussion

The present work reports the results of a retrospective investigation of 276 consecutive patients. Retrospective analyses in cancer therapy are not regarded as strong evidence these days. Nevertheless, we believe that our work is a valuable contribution to the current search for optimal treatment. Our study design and the characteristics of our treatment protocol fulfill many criteria of a prospective study; all patients received the multimodal therapy regime that has been unchanged since 1990.

Conclusion

These results underline the long-term reliability of preoperative radiochemotherapy and radical surgery in the treatment of advanced oral and oropharyngeal cancer.

Acknowledgement

This work was supported by research grant No. 10701 from the Anniversary Research Fund of the Oesterreichische National Bank (management by C. Klug).

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