Salvage therapy in relapsed squamous cell carcinoma of the oral cavity: how and when?

Abstract

Background: Relapse of tumors in patients with oral cavity squamous cell carcinoma (OSCC) is associated with a poor prognosis. In addition, salvage therapy may be a significant source of morbidity in patients with relapsing OSCC. The objective of the current study was to determine prognostic factors that predict which patients may benefit from such treatment.

Methods: From 953 patients who underwent primary radical surgery between 1996 and 2005, 272 patients with early-relapsed OSCC (n = 161) or late-relapsed OSCC (n = 111) were identified. The optimum cutoff point for relapse was chosen on the basis of 5-year disease-specific survival (DSS) and overall survival (OS).

Results: The optimal cutoff value for relapse was 10 months. Late relapses were associated with a better prognosis than relapses that occurred within the first 10 months (P < .0001 for both 5-year DSS and 5-year OS). Among patients with early-relapsed OSCC, a primary tumor depth <10 mm was associated significantly and independently with a better 5-year DSS (P = .014) and OS (P = .011). Among patients with late-relapsed OSCC, neck recurrence was a significant risk factor for adverse outcomes (P < .001 for both 5-year DSS and 5-year OS).

Conclusions: A late relapse was associated with better survival than a relapse that occurred within the first 10 months. Patients with late-relapsed OSCC may benefit from salvage therapy, especially those who have a local recurrence. Among patients with early-relapsed OSCC, salvage therapy should be considered for those who have a primary tumor depth <10 mm.