Treatment package time in high-risk oral cavity squamous cell carcinoma: where are we failing and at what cost?

BACKGROUND

The gold-standard of treatment for oral cavity squamous cell carcinoma (OCSCC) is surgery and adjuvant chemoradiotherapy (CRT) in the sub-group of high-risk patients. In this group of patients, treatment time is an important factor in clinical outcomes. We aim to study the influence of the treatment package time (TPT).

MATERIALS AND METHODS

We conducted a retrospective study of patients with high-risk OCSCC managed with surgery followed by adjuvant CRT between January 2017 and December 2020. TPT was defined as the time between surgery and the last fraction of radiotherapy. We categorized TPT according to an optimal cut-off point. The Kaplan-Meier methodology was used to calculate 5-year survival.

RESULTS

We included 79 patients, median age: 60 years (range: 39-70 years), majority were male (84.8%, n = 67) and smokers (73.4%, n = 58). Extra-nodal extension (ENE) and positive resection/< 1 mm margin were found in 51.9% (n = 41) and 84.8% (n = 67) of cases, respectively. Median radiotherapy dose: 66 Gy. Median cisplatin dose: 300 mg/m. Median TPT time was 109 days. The optimal cut-off point was 104 days. 5-year overall survival (OS) with TPT ≤ 104 days was 77.4% and 46.7% with TPT > 104 days, with similar results for disease-free survival (DFS).

CONCLUSIONS

Our institution cohort of high risk OCSSC treated with surgery followed by adjuvant CRT had a prolonged TPT (median 109 days). Within our cohort, a TPT > 104 days was found to have a worse OS and DFS, with a nonsignificant impact on locoregional or distant disease-free survival. This highlights the need to optimize the multimodal cancer care pathway.