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

Authors: Katsoulakis, E.; Leeman, J. E.; Lok, B. H.; Shi, W.; Zhang, Z.; Tsai, J. C.; McBride, S. M.; Sherman, E. J.; Cohen, M.; Wong, R.; Ganly, I.; Lee, N. Y.; Riaz, N.
Article Title: Long-term outcomes in oral cavity squamous cell carcinoma with adjuvant and salvage radiotherapy after surgery
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. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.
Keywords: adjuvant radiation; oral cavity squamous cell carcinoma; salvage radiation
Journal Title: Laryngoscope
Volume: 128
Issue: 11
ISSN: 0023-852X
Publisher: Wiley Blackwell  
Date Published: 2018-11-01
Start Page: 2539
End Page: 2545
Language: English
DOI: 10.1002/lary.27191
PROVIDER: scopus
PMCID: PMC6179950
PUBMED: 29637571
Notes: Laryngoscope -- Export Date: 2 January 2019 -- Article -- CODEN: LARYA C2 - 29637571 -- Source: Scopus
Citation Impact
MSK Authors
  1. Zhigang Zhang
    335 Zhang
  2. Weiji Shi
    121 Shi
  3. Eric J Sherman
    260 Sherman
  4. Nadeem Riaz
    333 Riaz
  5. Nancy Y. Lee
    729 Lee
  6. Richard J Wong
    318 Wong
  7. Ian Ganly
    350 Ganly
  8. Benjamin H Lok
    61 Lok
  9. Sean Matthew McBride
    229 McBride
  10. Jonathan Eric Leeman
    77 Leeman
  11. Chiaojung Jillian   Tsai
    212 Tsai
  12. Marc A Cohen
    74 Cohen