National Cancer Institute, Kyiv 03022 Ukraine.
Bogomolets National Medical University, Kyiv 01601 Ukraine.
Exp Oncol. 2020 Sep;42(3):228-232. doi: 10.32471/exp-oncology.2312-8852.vol-42-no-3.14873.
The aim of the study was to compare the efficacy of definitive chemoradiation therapy (CRT) and primary surgery followed by adjuvant radiotherapy (RT) or CRT in the management of patients with stage III-IVA-B resectable oral tongue squamous cell carcinoma (OTSCC).
It is a retrospective analysis of the treatment outcomes of 211 patients with stage III-IVA-B resectable OTSCC. The patients were divided into two groups depending on the treatment modality: 114 patients received surgery followed by adjuvant RT or CRT (S-RT/CRT) group; the definitive CRT group consisted of 97 patients.
The five-year overall survival (OS) was 57.0% in S-RT/CRT group vs 20.4% in CRT group; the five-year disease-free survival (DFS) in S-RT/CRT group was 56.5% vs 15.5%, in the CRT group. Comparison of survival curves revealed statistically significant higher OS and DFS rates in patients of S-RT/CRT group as compared with those in CRT patients (hazard ratio = 0.33 (95% confidence interval 0.23-0.47), p < 0.001 vs hazard ratio = 0.25 (95% confidence interval 0.17-0.37), p < 0.001). A multivariate analysis showed a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.004), cervical lymph node involvement cN2 (p < 0.001), cN3 (p = 0.04) and treatment modality (p < 0.001) on OS. There was also found a statistically significant prognostic effect of the primary tumor extension cT4 (p = 0.02), cervical lymph node involvement cN2 (p < 0.001) and treatment modality (p < 0.001) on DFS. 18 (15.8%) patients of S-RT/CRT group and 13 (13.4%) patients (p = 0.77) of CRT group developed mandibular osteoradionecrosis.
Primary surgery with adjuvant RT or CRT in advanced-stage resectable OTSCC significantly increases five-year OS and DFS rates as compared to those after definitive CRT.
比较根治性放化疗（CRT）与原发手术联合辅助放疗（RT）或 CRT 治疗可切除 III-IVA-B 期口腔舌鳞状细胞癌（OTSCC）患者的疗效。
回顾性分析 211 例可切除 III-IVA-B 期 OTSCC 患者的治疗结果。根据治疗方式将患者分为两组：114 例患者接受手术联合辅助 RT 或 CRT（S-RT/CRT）；97 例患者接受根治性 CRT（definitive CRT）。
S-RT/CRT 组 5 年总生存率（OS）为 57.0%，CRT 组为 20.4%；S-RT/CRT 组 5 年无病生存率（DFS）为 56.5%，CRT 组为 15.5%。生存曲线比较显示，S-RT/CRT 组的 OS 和 DFS 率明显高于 CRT 组（风险比=0.33（95%置信区间 0.23-0.47），p<0.001；风险比=0.25（95%置信区间 0.17-0.37），p<0.001）。多因素分析显示，原发肿瘤扩展 cT4（p=0.004）、颈部淋巴结受累 cN2（p<0.001）、cN3（p=0.04）和治疗方式（p<0.001）对 OS 有统计学显著的预后影响。原发肿瘤扩展 cT4（p=0.02）、颈部淋巴结受累 cN2（p<0.001）和治疗方式（p<0.001）对 DFS 也有统计学显著的预后影响。S-RT/CRT 组有 18 例（15.8%）和 CRT 组有 13 例（13.4%）（p=0.77）发生下颌骨放射性骨坏死。
与根治性 CRT 相比，原发手术联合辅助 RT 或 CRT 治疗晚期可切除 OTSCC 可显著提高 5 年 OS 和 DFS 率。
