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The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma.
Int J Oral Maxillofac Surg. 2020 Jun 29 [Online ahead of print]IJ

Abstract

The effectiveness of postoperative radiotherapy (PORT) in improving outcomes remains debatable for oral squamous cell carcinoma (OSCC) patients with pathological intermediate-risk factors (IRFs) after surgery. A retrospective analysis was conducted on 432 intermediate-risk OSCC patients defined by histological reporting of close margin (<5mm), early nodal disease (pN1), depth of invasion/tumour thickness ≥5mm, perineural invasion, and/or lymphovascular invasion. Outcomes measured were disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). PORT was associated with an improvement in 5-year DFS on univariable analysis (80% vs 71%; P=0.044), but this did not remain significant on multivariable analysis. PORT was not associated with differences in DSS or OS. The surgical salvage rate was similar in the PORT and surgery-only groups (41% vs 47%; P=0.972). Perineural invasion was found to be an independent predictor of inferior DSS (hazard ratio (HR) 2.19), DFS (HR 1.89), and OS (HR 1.97). Significantly worse outcomes were observed for patients with ≥4 concurrent IRFs. The application of PORT was associated with lower rates of recurrence, but the benefit was less apparent on mortality. Patients with perineural invasion and multiple concurrent IRFs were found to be at greatest risk, representing a subset of intermediate-risk OSCC patients who may benefit from PORT.

Authors+Show Affiliations

Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia. Electronic address: timothy.liu@health.qld.gov.au.School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616305

Citation

Liu, T, et al. "The Utility of Postoperative Radiotherapy in Intermediate-risk Oral Squamous Cell Carcinoma." International Journal of Oral and Maxillofacial Surgery, 2020.
Liu T, David M, Batstone M, et al. The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2020.
Liu, T., David, M., Batstone, M., Clark, J., Low, T. H., Goldstein, D., Hope, A., Hosni, A., & Chua, B. (2020). The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. International Journal of Oral and Maxillofacial Surgery. https://doi.org/10.1016/j.ijom.2020.06.006
Liu T, et al. The Utility of Postoperative Radiotherapy in Intermediate-risk Oral Squamous Cell Carcinoma. Int J Oral Maxillofac Surg. 2020 Jun 29; PubMed PMID: 32616305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. AU - Liu,T, AU - David,M, AU - Batstone,M, AU - Clark,J, AU - Low,T-H, AU - Goldstein,D, AU - Hope,A, AU - Hosni,A, AU - Chua,B, Y1 - 2020/06/29/ PY - 2020/01/02/received PY - 2020/04/13/revised PY - 2020/06/11/accepted PY - 2020/7/4/entrez KW - Histological risk factor KW - Intermediate-risk KW - Oral cancer KW - Radiotherapy KW - Squamous cell carcinoma JF - International journal of oral and maxillofacial surgery JO - Int J Oral Maxillofac Surg N2 - The effectiveness of postoperative radiotherapy (PORT) in improving outcomes remains debatable for oral squamous cell carcinoma (OSCC) patients with pathological intermediate-risk factors (IRFs) after surgery. A retrospective analysis was conducted on 432 intermediate-risk OSCC patients defined by histological reporting of close margin (<5mm), early nodal disease (pN1), depth of invasion/tumour thickness ≥5mm, perineural invasion, and/or lymphovascular invasion. Outcomes measured were disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). PORT was associated with an improvement in 5-year DFS on univariable analysis (80% vs 71%; P=0.044), but this did not remain significant on multivariable analysis. PORT was not associated with differences in DSS or OS. The surgical salvage rate was similar in the PORT and surgery-only groups (41% vs 47%; P=0.972). Perineural invasion was found to be an independent predictor of inferior DSS (hazard ratio (HR) 2.19), DFS (HR 1.89), and OS (HR 1.97). Significantly worse outcomes were observed for patients with ≥4 concurrent IRFs. The application of PORT was associated with lower rates of recurrence, but the benefit was less apparent on mortality. Patients with perineural invasion and multiple concurrent IRFs were found to be at greatest risk, representing a subset of intermediate-risk OSCC patients who may benefit from PORT. SN - 1399-0020 UR - https://www.unboundmedicine.com/medline/citation/32616305/The_utility_of_postoperative_radiotherapy_in_intermediate-risk_oral_squamous_cell_carcinoma L2 - https://linkinghub.elsevier.com/retrieve/pii/S0901-5027(20)30214-9 DB - PRIME DP - Unbound Medicine ER -
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