Surgery Plus RT Improves Survival Over Chemo Plus RT in Oral Cavity Carcinoma

Surgery followed by postoperative radiotherapy (S+PORT) was associated with prolonged overall survival compared with concurrent chemoradiotherapy (chemo-RT) in patients with locally advanced oral cavity squamous cell carcinoma (OCSCC), according to a new study.

“In locally advanced OCSCCs, S+PORT has been the preferred treatment because of improved reconstruction techniques and the poor outcomes of locally advanced OCSCCs treated with definitive radiotherapy,” wrote study authors led by Michael T. Spiotto, MD, PhD, of the University of Chicago Medical Center. Those poor outcomes, however, were based on small studies often in patients with poor performance status or unresectable tumors.

This study used the National Cancer Database to compare chemo-RT with S+PORT in a total of 6,900 patients with stage III to IVA OCSCC treated from 2004 through 2012. Of those, 4,809 received S+PORT, and 2,091 received chemo-RT. Results of the analysis were published in JAMA Otolaryngology – Head & Neck Surgery.

Patients treated with chemo-RT were more likely than those treated with S+PORT to be over 60 years of age, to have been treated prior to 2007, had more comorbidities, and were more likely to have T3 to T4a tumors. Among all patients, S+PORT was associated with improved overall survival, with a 3-year overall survival rate of 53.9% compared with 37.8% with chemo-RT, for a difference of 16.1%.

The researchers conducted a propensity matched analysis to compare patients with similar clinical variables. In those patients, S+PORT still yielded better survival outcomes, with a 3-year overall survival rate of 51.8% compared with 39.3% with chemo-RT, for a difference of 11.9%.

This difference was sharpest among patients with T3 to T4a tumors; in these patients, the 3-year overall survival rate with S+PORT was 49.7%, compared with 36.0% with chemo-RT, for a difference of 16.1%. In those with T1 to T2 tumors, the 3-year overall survival rate with S+PORT was 59.1%, compared with 53.5% with chemo-RT, for a difference of 5.6%.

“This study found that S+PORT improves survival compared with chemoradiotherapy for locally advanced OCSCC,” the authors concluded, noting that the study is limited by its nonrandomized, retrospective design, and by a lack of information on specific chemotherapy agents and other variables. “Given the improved results with S+PORT, this study further supports the premise that organ preservation should not be the primary goal for treating locally advanced OCSCC with chemoradiotherapy.”