Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery

Objectives: Evaluation of the hemostatic effect of trans-arterial embolization on patients with advanced oral cavity cancer who had bleeding complications while undergoing definitive concurrent chemoradiotherapy (CCRT). Additionally, assess the effect of trans-arterial embolization on treatment response following concurrent chemoradiotherapy, as well as overall survival (OS) and progression-free survival (PFS) in the group of patients following the intervention. Method: From September 2018–June 2021, a retrospective descriptive study was conducted on 16 patients with inoperable, locally advanced oral cavity cancer who received definitive concurrent chemoradiotherapy, experienced acute bleeding complications, and received selective intravascular intervention with various embolization materials at Vietnam National Cancer Hospital. Results: After selective embolization, 16/16 patients ceased bleeding; 1 patient re-bled for the second time after 3 weeks. The average duration of chemoradiotherapy interruption due to intervention was 6.7 days. After CCRT, 15/16 (93.75%) patients achieved a response, with 9/16 (56.25%) patients achieving a complete response. The median OS was 14 months (range, 3–26 months), and the median PFS was 10 months (range, 3–20 months). There were no significant complications, particularly neurological side effects. ConclusionsTumor bleeding is a common and serious complication of CCRT treatment in patients with locally advanced oral cavity cancer. Embolization is a safe and effective method of controlling acute bleeding that has no adverse effect on the outcome of definitive concurrent chemoradiotherapy.

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Retrospective Analysis: Postoperative CCRT Improved Treatment Outcome of Oral Cavity Cancer With Multiple Nodal Metastases but Without Extracapsular Spreading

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1224 ◽

2012 ◽

Vol 84 (3) ◽

pp. S462

Author(s):

K. Fan ◽

N. Tsang ◽

J. Chang ◽

C. Lin ◽

C. Liao ◽

...

Keyword(s):

Treatment Outcome ◽

Oral Cavity ◽

Retrospective Analysis ◽

Oral Cavity Cancer ◽

Nodal Metastases

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Metabolic Tumor Volume as a Prognostic Factor for Oral Cavity Cancer Treated with Primary Surgery

Otolaryngology ◽

10.1177/0194599814541627a98 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P60-P60

Author(s):

Han Zhang ◽

Jonathan T. Abele ◽

Dean T. Jeffery ◽

Hadi Seikaly ◽

Jeffrey R. Harris ◽

...

Keyword(s):

Prognostic Factor ◽

Oral Cavity ◽

Tumor Volume ◽

Oral Cavity Cancer ◽

Metabolic Tumor Volume ◽

Primary Surgery

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Cost-Effectiveness Analysis of Elective Neck Dissection in Patients With Clinically Node-Negative Oral Cavity Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.4563 ◽

2016 ◽

Vol 34 (32) ◽

pp. 3886-3891 ◽

Cited By ~ 15

Author(s):

Joseph R. Acevedo ◽

Katherine E. Fero ◽

Bayard Wilson ◽

Assuntina G. Sacco ◽

Loren K. Mell ◽

...

Keyword(s):

Cost Effectiveness ◽

Oral Cavity ◽

Neck Dissection ◽

Oral Cavity Cancer ◽

Early Stage ◽

Cost Effective ◽

Disease Recurrence ◽

Elective Neck Dissection ◽

Node Negative ◽

Primary Surgery

Purpose Recently, a large randomized trial found a survival advantage among patients who received elective neck dissection in conjunction with primary surgery for clinically node-negative oral cavity cancer compared with those receiving primary surgery alone. However, elective neck dissection comes with greater upfront cost and patient morbidity. We present a cost-effectiveness analysis of elective neck dissection for the initial surgical management of early-stage oral cavity cancer. Methods We constructed a Markov model to simulate primary, adjuvant, and salvage therapy; disease recurrence; and survival in patients with T1/T2 clinically node-negative oral cavity squamous cell carcinoma. Transition probabilities were derived from clinical trial data; costs (in 2015 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollar per quality-adjusted life-year (QALY), were calculated with incremental cost-effectiveness ratios less than $100,000/QALY considered cost effective. We conducted one-way and probabilistic sensitivity analyses to examine model uncertainty. Results Our base-case model found that over a lifetime the addition of elective neck dissection to primary surgery reduced overall costs by $6,000 and improved effectiveness by 0.42 QALYs compared with primary surgery alone. The decrease in overall cost despite the added neck dissection was a result of less use of salvage therapy. On one-way sensitivity analysis, the model was most sensitive to assumptions about disease recurrence, survival, and the health utility reduction from a neck dissection. Probabilistic sensitivity analysis found that treatment with elective neck dissection was cost effective 76% of the time at a willingness-to-pay threshold of $100,000/QALY. Conclusion Our study found that the addition of elective neck dissection reduces costs and improves health outcomes, making this a cost-effective treatment strategy for patients with early-stage oral cavity cancer.

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Concurrent Chemoradiotherapy Induces Body Composition Changes in Locally Advanced Head and Neck Squamous Cell Carcinoma: Comparison between Oral Cavity and Non-Oral Cavity Cancer

Nutrients ◽

10.3390/nu13092969 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2969

Author(s):

Yu-Ching Lin ◽

Hang Huong Ling ◽

Pei-Hung Chang ◽

Yi-Ping Pan ◽

Cheng-Hsu Wang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Body Composition ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Concurrent Chemoradiotherapy ◽

Oral Cavity Cancer ◽

Locally Advanced ◽

Advanced Head ◽

Treatment Interval

Few prospective cohort trials have evaluated the difference in treatment-interval total body composition (TBC) changes assessed by dual-energy X-ray absorptiometry (DXA) between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC) receiving concurrent chemoradiotherapy (CCRT): oral cavity cancer with adjuvant CCRT (OCC) and non-oral cavity with primary CCRT (NOCC). This study prospectively recruited patients with LAHNSCC. Clinicopathological variables, blood nutritional/inflammatory markers, CCRT-related factors, and TBC data assessed by DXA before and after treatment were collected. Multivariate linear regression analysis identified the factors associated with treatment-interval changes in body composition parameters, including lean body mass (LBM), total fat mass (TFM), and bone mineral content (BMC). A total of 127 patients (OCC (n = 69) and NOCC (n = 58)) were eligible. Body composition parameters were progressively lost during CCRT in both subgroups. Extremities lost more muscle mass than the trunk for LBM, whereas the trunk lost more fat mass than the extremities for TFM. BMC loss preferentially occurred in the trunk region. Different factors were independently correlated with the interval changes of each body composition parameter for both OCC and NOCC subgroups, particularly mean daily calorie intake for LBM and TFM loss, and total lymphocyte count for BMC loss. In conclusion, treatment-interval TBC changes and related contributing factors differ between the OCC and NOCC subgroups.

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