Influence of treatment package time on outcomes in high-risk oral cavity carcinoma in patients receiving adjuvant radiation and concurrent systemic therapy: A multi-institutional oral cavity collaborative study Journal Article
| Authors: | Ghanem, A. I.; Woody, N. M.; Schymick, M. A.; Joshi, N. P.; Geiger, J. L.; Tsai, C. J.; Dunlap, N. E.; Liu, H. Y.; Burkey, B. B.; Lamarre, E. D.; Ku, J. A.; Scharpf, J.; Caudell, J. J.; Porceddu, S. V.; Lee, N. Y.; Adelstein, D. J.; Koyfman, S. A.; Siddiqui, F. |
| Article Title: | Influence of treatment package time on outcomes in high-risk oral cavity carcinoma in patients receiving adjuvant radiation and concurrent systemic therapy: A multi-institutional oral cavity collaborative study |
| Abstract: | Objectives: To explore the influence of treatment package time(TPT) in high-risk oral cavity squamous cell carcinoma(OCSCC) receiving adjuvant radiotherapy with concurrent chemotherapy(CRT). Materials and Methods: We queried our multi-institutional OCSCC collaborative database for cases diagnosed between 2005 and 2015 who underwent surgery followed by adjuvant CRT. All patients had high-risk features: extranodal extension(ENE) and/or positive surgical margin(PM). TPT was days between surgery to last radiotherapy fraction. Kaplan-Meier curves, log-rank p-values and multivariate analysis(MVA) were used to investigate the impact of TPT on overall(OS), disease-free(DFS), locoregional failure-free(LRFS) and distant metastases-free(DMFS) survival. Results: We identified 187 cases: median age 58 (range, 24–87 years), males 66%, and ever smokers 69%. ENE and PM were detected in 85% and 32%, and oral tongue and floor of the mouth constituted 49% and 18%, respectively. Median radiotherapy and cisplatin doses received were 66 Gy and 200 mg/m2. Overall, median TPT was 98 (range, 63–162 days). OS was worse for TPT > 90-days (n = 134) than TPT ≤ 90 (n = 53) at two-(65% vs. 71%) and five-years (45% vs. 62%); p = 0.05, with similar results for DFS. No influence on LRFS or DMFS was noted. More lymph nodes(LN) dissected(P = 0.039), T3-4 disease(P = 0.017), and unplanned reoperations(P = 0.037) occurred with TPT > 90-days. On MVA, TPT in 10-day increments was independently detrimental for OS (Hazard Ratio: 1.14; 95 %Confidence Interval [1–1.28]; P = 0.043), perineural invasion, age and positive LN (p < 0.05 for all). Conclusion: In one of the largest multi-institutional cohorts, TPT > 90-days predicted worse OS for high-risk OCSCC receiving adjuvant CRT. All efforts are needed to optimize perioperative care and baseline conditions for favorable outcomes. © 2022 Elsevier Ltd |
| Keywords: | survival; squamous cell carcinoma; radiation therapy; oral cavity cancer; concomitant chemotherapy; high-risk patients; treatment package time |
| Journal Title: | Oral Oncology |
| Volume: | 126 |
| ISSN: | 1368-8375 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-03-01 |
| Start Page: | 105781 |
| Language: | English |
| DOI: | 10.1016/j.oraloncology.2022.105781 |
| PROVIDER: | scopus |
| PUBMED: | 35183910 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 March 2022 -- Source: Scopus |
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