Postoperative radiotherapy for patients with oral squamous cell ...

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James S. Brown, MD, FRCS1,6. 1Liverpool Head and Neck Cancer Unit,. Aintree University Hospital, Liverpool,. Merseyside, United Kingdom. 2Sydney Head ...
Received: 3 May 2016

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Revised: 13 October 2016

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Accepted: 9 February 2017

DOI 10.1002/hed.24780

ORIGINAL ARTICLE

Postoperative radiotherapy for patients with oral squamous cell carcinoma with intermediate risk of recurrence: A case match study Conor P. Barry, FRCS1,2,3,4 | Daniel Wong, MD1 | Jonathan R. Clark, FRACS2,5 | Richard J. Shaw, MD, FRCS1,6

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Ruta Gupta, MD, FRCPA3,7 |

Patrick Magennis, FRCS1 | Asterios Triantafyllou, PhD, FRCPath1 | Kan Gao, BEng2 | James S. Brown, MD, FRCS1,6 1 Liverpool Head and Neck Cancer Unit, Aintree University Hospital, Liverpool, Merseyside, United Kingdom

Abstract Background: The purpose of this study was to determine the effect of postoperative radiotherapy

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Sydney Head and Neck Cancer Institute, Chris O Brien Lifehouse, Sydney, New South Wales, Australia 3

National Maxillofacial Unit, St. James’s Hospital, Dublin, Ireland

(PORT) on recurrence and survival in patients with oral squamous cell carcinoma (OSCC) of intermediate recurrence risk. Methods: Intermediate risk patients, defined as pT1, pT2, pN0, or pN1 with at least one adverse pathological feature (eg, lymphovascular/perineural invasion), were identified from the head and

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Dublin Dental University Hospital, Dublin, Ireland 5

Central Clinical School, University of Sydney, Sydney, New South Wales, Australia 6

Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Merseyside, United Kingdom 7

Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia Correspondence Conor Barry, National Maxillofacial Unit, St. James’s Hospital, Dublin 8, Ireland Email: [email protected]

neck databases of the Liverpool Head and Neck Cancer Unit and the Sydney Head and Neck Cancer Institute. Patients who received surgery and PORT were case matched with patients treated by surgery alone based on pN, pT, margins, and pathological features. Results: Ninety patients were matched into 45 pairs. There was significant improvement (P 5 .039) in locoregional control with PORT (84%) compared with surgery alone (60%), which was concentrated in the pN1 subgroup (P 5 .036), but not the pN0 subgroup (P 5 .331). Conclusion: PORT significantly improves locoregional control for intermediate risk OSCC. KEYWORDS

case-matched cohort study, locoregional control, oral cancer, postoperative radiotherapy, survival, T1/T2

1 | INTRODUCTION

particularly those with multiple nodal metastases, extracapsular spread (ECS) or positive margins have a high risk of recurrence and adjuvant

Oral squamous cell carcinoma (OSCC) is usually treated by primary

therapy is essential. The remaining patients generally fall into an inter-

surgery.1 The need for adjuvant therapy, in particular postoperative

mediate risk group. The decisions regarding the need for adjuvant ther-

radiotherapy (PORT), is based on a synthesis of several clinical and

apy are based on institutional preferences, clinical acumen, and patient

pathological adverse features that increase the risk of locoregional

preference and are supported only by low-level contradictory evi-

failure. Patients at low risk of recurrence, in which PORT can be safely

dence.2 This group includes node-negative patients with close margins

omitted, are those with primary tumors