Kim Tae Hyung, Cha In-Ho, Choi Eun Chang, Kim Hye Ryun, Kim Hyung Jun, Kim Se-Heon, Keum Ki Chang, Lee Chang Geol
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Department of Radiation Oncology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, South Korea.
Front Oncol. 2021 Mar 12;11:619372. doi: 10.3389/fonc.2021.619372. eCollection 2021.
BACKGROUND/PURPOSE: Surgery followed by postoperative radiotherapy (RT) has been considered the standard treatment for oral cavity squamous cell carcinoma (OCSCC) of advanced stages or with adverse prognostic factors. In this study, we compared the outcomes in patients with OCSCC who received postoperative concurrent chemoradiotherapy (CCRT) or postoperative RT alone using modern RT techniques.
A total of 275 patients with OCSCC treated between 2002 and 2018 were retrospectively analyzed. Adverse prognostic factor was defined as extranodal extension (ENE), microscopically involved surgical margin, involvement of ≥2 lymph nodes, perineural disease, and/or lymphovascular invasion (LVI). In total, 148 patients (54%) received CCRT and 127 patients (46%) received RT alone. More patients in the CCRT group had N3 disease and stage IVB disease (46.6% 10.2%, <0.001), ENE (56.1% 15.7%, <0.001), LVI (28.4% 13.4%, =0.033).
With a median follow-up of 40 (range, 5-203) months, there were no significant differences in the 5-year overall survival (OS) and PFS between treatment groups. In the subgroup analysis according to high risk, the concurrent use of chemotherapy showed significantly improved OS in patients with ENE (HR 0.39, =0.003).
Our retrospective study showed that postoperative CCRT group had comparable survival outcomes to those in the RT alone group for advanced OCSCC in the era of modern RT techniques and indicated that concurrent chemotherapy should be administered to patients with ENE. Prospective randomized studies for confirmation are needed.
背景/目的：手术联合术后放疗（RT）一直被视为晚期或具有不良预后因素的口腔鳞状细胞癌（OCSCC）的标准治疗方法。在本研究中，我们比较了采用现代放疗技术接受术后同步放化疗（CCRT）或单纯术后放疗的OCSCC患者的治疗结果。
回顾性分析了2002年至2018年间治疗的275例OCSCC患者。不良预后因素定义为结外扩展（ENE）、镜下手术切缘受累、≥2个淋巴结受累、神经周围侵犯和/或淋巴管侵犯（LVI）。共有148例患者（54%）接受了CCRT，127例患者（46%）接受了单纯放疗。CCRT组中更多患者患有N3期疾病和IVB期疾病（46.6%对10.2%，<0.001）、ENE（56.1%对15.7%，<0.001）、LVI（28.4%对13.4%，=0.033）。
中位随访40（范围5 - 203）个月，治疗组之间的5年总生存率（OS）和无进展生存率（PFS）无显著差异。在根据高风险进行的亚组分析中，同步使用化疗在患有ENE的患者中显示出OS显著改善（HR 0.39，=0.003）。
我们的回顾性研究表明，在现代放疗技术时代，晚期OCSCC患者术后CCRT组的生存结果与单纯放疗组相当，并表明应给予患有ENE的患者同步化疗。需要进行前瞻性随机研究以证实。
