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. 2017 Jun;127(6):1334-1338.
doi: 10.1002/lary.26443. Epub 2017 Feb 1.

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Suresh Mohan  1 , Sara I Pai  2 , Neil Bhattacharyya  3
Affiliations

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Suresh Mohan et al. Laryngoscope. 2017 Jun.

Abstract

Objective: To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity.

Study design: Cross-sectional population analysis.

Methods: Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT.

Results: A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC.

Conclusion: Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence.

Level of evidence: 2C. Laryngoscope, 127:1334-1338, 2017.

Keywords: SEER; T stage; Verrucous carcinoma; cancer; head and neck cancer; oral cavity; radiation therapy; survival.

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Figures

Fig. 1.
Fig. 1.
(A) Overall survival (P = 0.119), B) Disease-specific survival (P = 0.05) based on overall pooled data for verrucous carcinoma patients treated with or without adjuvant radiation therapy. Cum = cumulative; RT = radiation therapy; Sx = surgery.
Fig. 2.
Fig. 2.
(A) Overall survival (P = 0.992), (B) Disease-specific survival (P = 0.275) based on overall pooled data for verrucous carcinoma versus SCC patients treated with adjuvant radiation therapy. Cum = cumulative; SCC = squamous cell carcinoma; VC = verrucous carcinoma.
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