nach oben

Erschienen in:

24.11.2023 | Original Article

Clinical outcomes and failure patterns after postoperative radiotherapy for oral cavity squamous cell carcinoma

verfasst von: Saori Tatsuno, Hiroshi Doi, MD, PhD, Masahiro Inada, Takuya Uehara, Yutaro Wada, Kazuki Ishikawa, Kaoru Tanaka, Mutsukazu Kitano, Yasumasa Nishimura

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 5/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study aimed to assess recurrence patterns and identify the optimal dose and target volumes of postoperative radiotherapy (PORT) in patients with oral cavity squamous cell carcinoma (OSCC).

Methods

Data of 111 patients who received PORT for OSCC between January 2010 and April 2020 were retrospectively reviewed. The median age was 68 years (range 19–88). PORT was administered as initial treatment to 63 patients and as salvage treatment for recurrent tumors to 48 patients. The median prescribed dose was 60 Gy (range 50–66) administered in 30 fractions (range 25–33).

Results

Median follow-up time was 73 months (range 24–147). Overall survival (OS), progression-free survival (PFS), local control (LC), and locoregional control (LRC) at 3 years were 55.6%, 45.6%, 74.6%, and 63.1%, respectively. There were no significant differences in OS, PFS, LC, and LRC between the initially diagnosed and postoperative recurrent cases. Of 22 patients (20%) who developed regional nodal recurrences, 17 (15%) and 11 (10%) had in-field and out-of-field recurrences, respectively. Of 105 patients who received irradiation to the primary tumor bed, 24 (23%) developed recurrence at the primary site. The PFS and LC rates were significantly worse in patients receiving ≤ 56 Gy to the primary site than those receiving > 56 Gy (p = 0.016 and p = 0.032, respectively).

Conclusion

PORT was effective for postoperative recurrences as well as for initially diagnosed oral cavity cancer. Doses greater than 56 Gy to the primary site may be required in PORT for OSCC.

Nur mit Berechtigung zugänglich

Lavaf A, Genden EM, Cesaretti JA, Packer S, Kao J (2008) Adjuvant radiotherapy improves overall survival for patients with lymph node-positive head and neck squamous cell carcinoma. Cancer 112:535–543. https://doi.org/10.1002/cncr.23206CrossRefPubMed

Gore SM, Crombie AK, Batstone MD, Clark JR (2015) Concurrent chemoradiotherapy compared with surgery and adjuvant radiotherapy for oral cavity squamous cell carcinoma. Head Neck 37:518–523. https://doi.org/10.1002/hed.23626CrossRefPubMed

Spiotto MT, Jefferson G, Wenig B, Markiewicz M, Weichselbaum RR, Koshy M (2017) Differences in survival with surgery and postoperative radiotherapy compared with definitive chemoradiotherapy for oral cavity cancer: a national cancer database analysis. JAMA Otolaryngol Head Neck Surg 143:691–699. https://doi.org/10.1001/jamaoto.2017.0012CrossRefPubMedPubMedCentral

Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952. https://doi.org/10.1056/NEJMoa032641CrossRefPubMed

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944. https://doi.org/10.1056/NEJMoa032646CrossRefPubMed

Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefèbvre JL (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27:843–850. https://doi.org/10.1002/hed.20279CrossRefPubMed

Winquist E, Oliver T, Gilbert R (2007) Postoperative chemoradiotherapy for advanced squamous cell carcinoma of the head and neck: a systematic review with meta-analysis. Head Neck 29:38–46. https://doi.org/10.1002/hed.20465CrossRefPubMed

Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, Morrison WH, Weber RS, Garden AS, Frankenthaler RA, Oswald MJ (1993) Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys 26:3–11. https://doi.org/10.1016/0360-3016(93)90167-tCrossRefPubMed

Waldram R, Taylor AE, Whittam S, Iyizoba-Ebozue Z, Murray L, Frood R, Cardale K, Dyker KE, Murray P, Ramasamy S, Sen M (2020) Evaluation of locoregional recurrence patterns following adjuvant (chemo)radiotherapy for oral cavity carcinoma. Clin Oncol (r Coll Radiol) 32:228–237. https://doi.org/10.1016/j.clon.2019.10.002CrossRefPubMed

10.

Geretschläger A, Bojaxhiu B, Crowe S, Arnold A, Manser P, Hallermann W, Aebersold DM, Ghadjar P (2012) Outcome and patterns of failure after postoperative intensity modulated radiotherapy for locally advanced or high-risk oral cavity squamous cell carcinoma. Radiat Oncol 7:175. https://doi.org/10.1186/1748-717X-7-175CrossRefPubMedPubMedCentral

11.

Chan AK, Huang SH, Le LW, Yu E, Dawson LA, Kim JJ, Cho BJ, Bayley AJ, Ringash J, Goldstein D, Chan K (2013) Postoperative intensity-modulated radiotherapy following surgery for oral cavity squamous cell carcinoma: patterns of failure. Oral Oncol 49:255–260. https://doi.org/10.1016/j.oraloncology.2012.09.006CrossRefPubMed

12.

Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136. https://doi.org/10.1016/S1470-2045(10)70290-4CrossRefPubMedPubMedCentral

13.

Haddadin KJ, Soutar DS, Oliver RJ, Webster MH, Robertson AG, MacDonald DG (1999) Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 21:517–525. https://doi.org/10.1002/(SICI)1097-0347(199909)21:6%3C517::AID-HED4%3E3.0.CO;2-CCrossRefPubMed

14.

Dias FL, Kligerman J, Matos de Sá G, Arcuri RA, Freitas EQ, Farias T, Matos F, Lima RA (2001) Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth. Otolaryngol Head Neck Surg 125:23–29. https://doi.org/10.1067/mhn.2001.116188CrossRefPubMed

15.

Porceddu SV, Campbell B, Rischin D, Corry J, Weih L, Guerrieri M, Grossi M, Peters LJ (2004) Postoperative chemoradiotherapy for high-risk head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 60:365–373. https://doi.org/10.1016/j.ijrobp.2004.03.011CrossRefPubMed

16.

Sobin LH, Gospodarowicz MK, Wittekind C (2011) TNM classification of malignant tumours. John Wiley & Sons, New York

17.

Omura K (2014) Current status of oral cancer treatment strategies: surgical treatments for oral squamous cell carcinoma. Int J Clin Oncol 19:423–430. https://doi.org/10.1007/s10147-014-0689-zCrossRefPubMed

18.

Grégoire V, Eisbruch A, Hamoir M, Levendag P (2006) Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol 79:15–20. https://doi.org/10.1016/j.radonc.2006.03.009CrossRefPubMed

19.

Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, Lee A, Le QT, Maingon P, Nutting C, O’Sullivan B (2014) Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol 110:172–181CrossRefPubMed

20.

Biau J, Lapeyre M, Troussier I, Budach W, Giralt J, Grau C, Kazmierska J, Langendijk JA, Ozsahin M, O’Sullivan B, Bourhis J (2019) Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 update. Radiother Oncol 134:1–9. https://doi.org/10.1016/j.radonc.2019.01.018CrossRefPubMed

21.

Lambade PN, Lambade D, Goel M (2013) Osteoradionecrosis of the mandible: a review. Oral Maxillofac Surg 17:243–249. https://doi.org/10.1007/s10006-012-0363-4CrossRefPubMed

22.

Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, Bentzen SM, Nam J, Deasy JO (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:S10–S19. https://doi.org/10.1016/j.ijrobp.2009.07.1754CrossRefPubMedPubMedCentral

23.

Suzuki M, Nishimura Y, Nakamatsu K, Okumura M, Hashiba H, Koike R, Kanamori S, Shibata T (2006) Analysis of interfractional set-up errors and intrafractional organ motions during IMRT for head and neck tumors to define an appropriate planning target volume (PTV)- and planning organs at risk volume (PRV)-margins. Radiother Oncol 78:283–290. https://doi.org/10.1016/j.radonc.2006.03.006CrossRefPubMed

24.

Kiyota N, Tahara M, Mizusawa J, Kodaira T, Fujii H, Yamazaki T, Mitani H, Iwae S, Fujimoto Y, Onozawa Y, Hanai N, Ogawa T, Hara H, Monden N, Shimura E, Minami S, Fujii T, Tanaka K, Homma A, Yoshimoto S, Oridate N, Omori K, Ueda T, Okami K, Ota I, Shiga K, Sugasawa M, Asakage T, Saito Y, Murono S, Nishimura Y, Nakamura K, Hayashi R, Head and Neck Cancer Study Group of the Japan Clinical Oncology Group (JCOG-HNCSG) et al (2022) Weekly cisplatin plus radiation for postoperative head and neck cancer (JCOG1008): a multicenter, noninferiority, phase II/III randomized controlled trial. J Clin Oncol 40:1980–1990. https://doi.org/10.1200/JCO.21.01293CrossRefPubMedPubMedCentral

25.

Hamauchi S, Yokota T, Mizumachi T, Onozawa Y, Ogawa H, Onoe T, Kamijo T, Iida Y, Nishimura T, Onitsuka T, Yasui H, Homma A (2019) Safety and efficacy of concurrent carboplatin or cetuximab plus radiotherapy for locally advanced head and neck cancer patients ineligible for treatment with cisplatin. Int J Clin Oncol 24:468–475. https://doi.org/10.1007/s10147-018-01392-9CrossRefPubMed

26.

Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354:567–578. https://doi.org/10.1056/NEJMoa053422CrossRefPubMed

27.

Lin CH, Lin CY, Fan KH, Hung SP, Chou YC, Liu CJ, Chou WC, Chen YC, Huang SF, Kang CJ, Chang KP (2021) Efficacy of postoperative unilateral neck irradiation in patients with buccal mucosa squamous carcinoma with extranodal extension: A propensity score analysis. Cancers (Basel) 13:5997CrossRefPubMed

28.

Chen PY, Chen HH, Hsiao JR, Yang MW, Hsueh WT, Tasi ST, Lin FC, Wu YH (2012) Intensity-modulated radiotherapy improves outcomes in postoperative patients with squamous cell carcinoma of the oral cavity. Oral Oncol 48:747–752. https://doi.org/10.1016/j.oraloncology.2012.02.010CrossRefPubMed

29.

D’Cruz AK, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, Agarwal JP, Pantvaidya G, Chaukar D, Deshmukh A, Kane S (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529. https://doi.org/10.1056/NEJMoa1506007CrossRefPubMed

30.

Lin CY, Lee LY, Huang SF, Kang CJ, Fan KH, Wang HM, Chen EY, Chen IH, Liao CT, Cheng AJ, Chang JT (2008) Treatment outcome of combined modalities for buccal cancers: unilateral or bilateral neck radiation? Int J Radiat Oncol Biol Phys 70:1373–1381. https://doi.org/10.1016/j.ijrobp.2007.08.022CrossRefPubMed

31.

Rath S, Gandhi AK, Rastogi M, Khurana R, Hadi R, Singh HB, Nanda SS, Azam M, Srivastava A, Bharati A, Mishra SP (2020) Patterns of failure and clinical outcomes of post-operative buccal mucosa cancers treated with adjuvant ipsilateral radiotherapy. Radiat Oncol J 38:189–197. https://doi.org/10.3857/roj.2020.00458CrossRefPubMedPubMedCentral

32.

Rosenthal DI, Mohamed ASR, Garden AS, Morrison WH, El-Naggar AK, Kamal M, Weber RS, Fuller CD, Peters LJ (2017) Final report of a prospective randomized trial to evaluate the dose-response relationship for postoperative radiation therapy and pathologic risk groups in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 98:1002–1011. https://doi.org/10.1016/j.ijrobp.2017.02.218CrossRefPubMedPubMedCentral

33.

Goto Y, Kodaira T, Furutani K, Tachibana H, Tomita N, Ito J, Hanai N, Ozawa T, Hirakawa H, Suzuki H, Hasegawa Y (2013) Clinical outcome and patterns of recurrence of head and neck squamous cell carcinoma with a limited field of postoperative radiotherapy. Jpn J Clin Oncol 43:719–725. https://doi.org/10.1093/jjco/hyt066CrossRefPubMed

34.

Makita C, Kodaira T, Daimon T, Tachibana H, Tomita N, Koide Y, Koide Y, Fukuda Y, Nishikawa D, Suzuki H, Hanai N (2017) Comparisons of the clinical outcomes of different postoperative radiation strategies for treatment of head and neck squamous cell carcinoma. Jpn J Clin Oncol 47:1141–1150. https://doi.org/10.1093/jjco/hyx137CrossRefPubMed

35.

International Consortium for Outcome Research (ICOR) in Head and Neck Cancer, Ebrahimi A, Gil Z, Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, Kreppel M, Cernea CR, Brandao J (2014) Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study. JAMA Otolaryngol Head Neck Surg 140:1138–1148. https://doi.org/10.1001/jamaoto.2014.1548CrossRef

36.

Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours. John Wiley & Sons, New York

37.

Wreesmann VB, Katabi N, Palmer FL, Montero PH, Migliacci JC, Gönen M, Carlson D, Ganly I, Shah JP, Ghossein R, Patel SG (2016) Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma. Head Neck 38:E1192–E1199. https://doi.org/10.1002/hed.24190CrossRefPubMed

38.

Cramer JD, Samant S, Heron DE, Ferris RL, Kim S (2019) Impact of postoperative radiation therapy for deeply invasive oral cavity cancer upstaged to stage III. Head Neck 41:1178–1183. https://doi.org/10.1002/hed.25498CrossRefPubMedPubMedCentral

Titel: Clinical outcomes and failure patterns after postoperative radiotherapy for oral cavity squamous cell carcinoma
verfasst von: Saori Tatsuno
Hiroshi Doi, MD, PhD
Masahiro Inada
Takuya Uehara
Yutaro Wada
Kazuki Ishikawa
Kaoru Tanaka
Mutsukazu Kitano
Yasumasa Nishimura
Publikationsdatum: 24.11.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 5/2024
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-023-02171-w

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Clinical outcomes and failure patterns after postoperative radiotherapy for oral cavity squamous cell carcinoma