Surgery First Improves Oral Cancer Outcomes

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Surgery First Improves Oral Cancer Outcomes
Surgery First Improves Oral Cancer Outcomes

(HealthDay News) — For patients with oral cavity squamous cell carcinoma (OCSCC), outcomes are improved with surgery first, according to a study published online Dec. 26 in JAMA Otolaryngology-Head & Neck Surgery.

Steven B. Chinn, MD, from the University of Michigan in Ann Arbor, and colleagues retrospectively evaluated 19 patients with resectable stages III and IV OCSCC. The patients were enrolled into a phase 2 induction selection trial in which patients with a response of at least 50% underwent concurrent chemoradiotherapy, while those with a response of less than 50% underwent surgical treatment and radiotherapy. These patients were matched and compared with patients treated with primary surgical extirpation during a similar time period.

The Kaplan-Meier estimate for overall survival at 5 years was 32% in the induction selection cohort and 65% in the surgical cohort, according to the researchers. A similar estimate for disease-specific survival was 46% in the induction selection cohort and 75% in the surgical cohort at 5 years, and estimates for locoregional control at 5 years were 26% and 72%, respectively.

Multivariable analysis showed significantly better overall and disease-specific survival and locoregional control outcomes in the surgical cohort (P = 0.03, P = 0.001, and P < 0.001, respectively).

"Primary surgical treatment showed significantly better survival and locoregional control compared with [induction selection] in this matched patient cohort," the researchers wrote.

"Despite success of organ preservation [induction selection] protocols in the larynx, comparative survival analysis of an [induction selection] protocol vs. primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC."

References

  1. Chinn SB, Spector ME, Bellile EL, et al. Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients With Advanced Oral Cavity Carcinoma. JAMA Otolaryngol Head Neck Surg. 2013;doi:10.1001/jamaoto.2013.5892.

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