Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;128(11):2539-2545.
doi: 10.1002/lary.27191. Epub 2018 Apr 10.

Long-term outcomes in oral cavity squamous cell carcinoma with adjuvant and salvage radiotherapy after surgery

Evangelia Katsoulakis  1 , Jonathan E Leeman  2 , Benjamin H Lok  2 , Weiji Shi  3 , Zhigang Zhang  3 , Jillian C Tsai  2 , Sean M McBride  2 , Eric J Sherman  4 , Marc Cohen  5 , Richard Wong  5 , Ian Ganly  5 , Nancy Y Lee  2 , Nadeem Riaz  2
Affiliations

Long-term outcomes in oral cavity squamous cell carcinoma with adjuvant and salvage radiotherapy after surgery

Evangelia Katsoulakis et al. Laryngoscope. 2018 Nov.

Abstract

Objective: Early-stage oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients, and locoregional recurrence rates are as high as 25% with surgery alone. Radiotherapy (RT) is typically reserved as part of salvage multimodality therapy after salvage surgery because it is generally thought that there is no significant detriment to salvage therapy. Our aim was to examine outcomes for recurrent OCSCC treated with salvage surgery and radiation and compare them to outcomes for patients treated with adjuvant postoperative RT upfront.

Methods: We identified 425 patients with OCSCC treated with postoperative RT at our institution. The 5-year rates of local failure, locoregional failure (LRF), survival, and distant metastasis (DM) were the main outcome measures. We performed a landmark analysis and examined the same outcomes in the adjuvant versus salvage cohorts using Cox proportional hazards and Fine-Gray competing risk method.

Results: The adjuvant cohort had higher tumor (T) (P < 0.0001) and nodal (N) (P < 0.0001) stage than the salvage cohort's stage at initial presentation. On multivariate analysis, a strategy of salvage RT experienced poorer overall survival (OS) compared to upfront adjuvant RT (hazard ratio [HR] 1.84; 95% confidence interval [CI], 1.26-2.70; P = 0.002). Moreover, salvage surgery followed by RT patients experienced increasing risk of LRF (HR 1.56; 95% CI, 1.18-2.06; P = 0.002) and (DM) (HR 1.53; 95% CI, 1.08-2.17; P = 0.02) on multivariate analysis. Additional analysis was performed excluding salvage cohort with advanced disease at initial presentation (T3-T4 and N2). Salvage RT treatment selection for early-stage OCSCC continued to experience significantly poorer OS as compared to adjuvant RT (HR 1.48; 95% CI, 1.002-2.19; P = 0.049).

Conclusion: Early-stage OCSCC patients who are observed and experienced recurrence requiring salvage therapy (surgery and RT) have worse oncologic outcomes than locally advanced patients receiving upfront adjuvant RT. Prospective randomized studies are needed to identify high-risk subset of early-stage OCSCC comparing adjuvant RT versus observation, followed by salvage surgery and RT at recurrence.

Level of evidence: 4. Laryngoscope, 2539-2545, 2018.

Keywords: Adjuvant radiation; oral cavity squamous cell carcinoma; salvage radiation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: No potential conflicts of interest exist.

Figures

Figure 1
Figure 1. Outcomes in the adjuvant radiation cohort
(A) 5-year cumulative incidence curve of LRF after surgery for the adjuvant cohort. The 2- and 5- year LRF was 21% and 27%, respectively. (B) 5-year cumulative incidence curves of LRF by margin status for the adjuvant cohort. The 5-year LRF for negative margin was 17% vs 42% for close or positive margins, p<0.0001.
Figure 1
Figure 1. Outcomes in the adjuvant radiation cohort
(A) 5-year cumulative incidence curve of LRF after surgery for the adjuvant cohort. The 2- and 5- year LRF was 21% and 27%, respectively. (B) 5-year cumulative incidence curves of LRF by margin status for the adjuvant cohort. The 5-year LRF for negative margin was 17% vs 42% for close or positive margins, p<0.0001.
Figure 2
Figure 2
Comparison of overall survival between recurrent oral cavity cancer treated with salvage surgery and radiation versus adjuvant RT. Adjusted overall survival curves stratified by cohort are derived from the multivariate analysis Cox proportional hazards regression model.
Figure 3
Figure 3. Modern tools to examine the recurrence risk of the salvage cohort at initial presentation: Nomogram and AJCC 8th edition
(A) Salvage cohort and predicted 5year locoregional control with surgery versus surgery and adjuvant RT using the oral cavity nomogram. (B) Salvage cohort and AJCC restaging from the 7th to the 8th edition.
Figure 3
Figure 3. Modern tools to examine the recurrence risk of the salvage cohort at initial presentation: Nomogram and AJCC 8th edition
(A) Salvage cohort and predicted 5year locoregional control with surgery versus surgery and adjuvant RT using the oral cavity nomogram. (B) Salvage cohort and AJCC restaging from the 7th to the 8th edition.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA: a cancer journal for clinicians. 2017;67(1):7–30. - PubMed
    1. Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the oral tongue--clinicopathologic features affecting outcome. Cancer. 2012;118(1):101–111. - PubMed
    1. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral oncology. 2009;45(4–5):309–316. - PubMed

    1. 2.2016 NGV. Cancer of the Oral Cavity. 2017.

    1. Studer G, Furrer K, Davis BJ, et al. Postoperative IMRT in head and neck cancer. Radiation oncology. 2006;1:40. - PMC - PubMed

Publication types