Predictive score for recurrence after complete resection in locally advanced oral cavity squamous cell carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17536-e17536
Author(s):  
Hsueh-Ju Lu ◽  
Szu-Wen Tseng ◽  
Chih-Yu Peng ◽  
Hsien-Chun Tseng ◽  
Chung-Han Hsin ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Locally Advanced ◽  
Predictive Score ◽  
Depth Of Invasion ◽  
Training Cohort ◽  
Early Progression

e17536 Background: Early progression, usually defined disease-free interval (DFI) less than six months after completing adjuvant platinum-based chemoradiotherapy (CRT), has very poor outcome for oral cavity squamous cell carcinoma (OCSCC). But there are no biomarkers to predict such early progression. Methods: Locally advanced OCSCC patients, after complete surgical resection and followed-up platinum-based adjuvant CRT, were retrospectively enrolled from Chung Shan Medical University Hospital (CSMUH, training cohort) and Taipei Veterans General Hospital (TPE-VGH, validating cohort) in Taiwan. Clinicopathologic variables of patients with DFI < or ≥ 6 months were compared by using the χ2 test. The Cox proportional hazards model was applied to identify independent factors for DFI. Survival was estimated using the Kaplan-Meier method and log-rank test. Results: A total of 350 high-risk OCSCC patients were enrolled, including 146 patients in training cohort and 204 in validating cohort. In multivariate Cox regression, pN > 0, extracapular spread, and depth of invasion ( ≥ 1cm) were independent factors for DFI in training cohort. If each factor scored one point, the scoring system could effectively predict early progression that sensitivity/specificity/area under curve (AUC) of training and validating cohort were 57.7%/91.2%/0.771 and 58.1%/83.9%/0.730, respectively (the cutoff level ≤ 2 or > 2). DFI between lower- (score 0–2) and high- (score 3) risk groups were also significantly different in both training (median DFI, 59.6 vs. 4.5 months, P < 0.001) and validating cohorts (NA vs. 9.3 months, P < 0.001). Conclusions: The established score system was effective to predict early progression after adjuvant CRT for locally advanced OCSCC.

scholarly journals Free radial forearm flap for reconstruction of postoperative defects in combined and complex treatment of patients with locally-advanced squamous cell carcinoma of the oral cavity

2020 ◽  
Vol 10 (1) ◽  
pp. 55-64
Author(s):  
H. Chen ◽  
A. M. Mudunov ◽  
R. I. Azizian ◽  
I. N. Pustynskiy ◽  
O. A. Saprina ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Free Flap ◽  
Locally Advanced ◽  
Functional Results ◽  
Radial Forearm Free Flap ◽  
Flap Necrosis ◽  
Radial Forearm

The study objective is to assess immediate and long-term results of replacing complex defects with a free radial forearm flap in the multimodal treatment of patients with locally advanced oral cavity squamous cell carcinoma. Materials and methods. Twenty eight patients (20 women and 8 men aged 23 to 71 years) with locally advanced oral cavity squamous cell carcinoma (including 10 buccal cancers, 8 carcinomas of tongue, 6 carcinomas of the floor of the mouth, 2 retromolar area carcinomas, 1 carcinoma of the hard palate and 1 carcinoma of alveolar region of the lower jaw) underwent tumor surgery with simultaneous plastic reconstruction of the defect using radial forearm free flap at the department of head and neck tumors of N. N. Blokhin National Medical Research Center of Oncology within 2010–2018. Primary tumors were detected in 2 patients and 11 patients had residual (n = 7) or recurrent (n = 4) tumors after radiotherapy or chemoradiotherapy. Results. An overall success rate was 96.4 %. Postoperative histology revealed that there were no tumor cells at the resection edges. Postoperative complications included: complete flap necrosis in 1 patient with severe concomitant diseases, marginal flap necrosis in 2 patients (in both cases after the necrotic tissue had rejected, wounds were healed by secondary intention), sural veins thrombosis in 1 patient, acute peptic ulcer bleeding on the 6th day after surgery in 1 patient treated with emergency endoscopic hemostasis. No lethal outcomes were reported. Postoperative period lasted in average 14 days. Upon subsequent observation tumor relapse in the oral cavity occurred in 4 (14.3 %) patients, relapses of regional metastases – in 2 (7.1 %). Good aesthetic and functional results were noted. Adequate restoration of breathing, chewing, swallowing and speaking resulted in a full patients’ rehabilitation. In all cases, the radial flap adapted well to the oral cavity organs and corresponded to the surrounding tissues in thickness and consistency. Conclusion. Use of a radial forearm free flap makes it possible to successfully reconstruct extensive and complex defects after surgery of locally advanced primary and recurrent forms of oral cavity squamous cell cancer of various locations. Due to flap’s high regenerative capabilities, preoperative radiation therapy does not affect the frequency of local complications. It allows restoring vital functions of the oral cavity and achieving good aesthetic and functional results.

scholarly journals Low-dose aspirin confers a survival benefit in patients with pathological advanced-stage oral squamous cell carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheng-Dean Luo ◽  
Shao-Chun Wu ◽  
Wei-Chih Chen ◽  
Ching-Nung Wu ◽  
Tai-Jan Chiu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Survival Rates ◽  
Distant Metastases ◽  
Good Prognosis ◽  
High Rate

AbstractOral squamous cell carcinoma (OSCC) remains one of the most challenging clinical problems in the field due to its high rate of locoregional and distant metastases. However, studies that assess the association between aspirin use and survival in patients with OSCC are limited. Moreover, patients that recruited from those studies might have tumors that arose from different anatomic regions of the head and neck, including the oral cavity, oropharynx, etc. Since tumors within these distinct anatomic regions are unique in the context of epidemiology and tumor progression, we sought to evaluate the association of aspirin use with squamous cell carcinomas located within the oral cavity only. In this 10-year cohort study, we evaluated aspirin use and survival rates in relation to clinical characteristics as well as duration of aspirin use in patients with OSCC. Our findings suggest that OSCC patients with aspirin use for more than 180 days showed improved overall and disease-specific survival rates. Aspirin also improves survival in patients across various stages of OSCC. Cox regression models indicated that aspirin use was associated with a good prognosis. In conclusion, this evidence indicates that aspirin may be potentially used as an adjuvant therapy for OSCC.

Upfront chemotherapy and accelerated radiotherapy with EGFR inhibition for locally advanced inoperable head and neck cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6040-6040
Author(s):  
C. Mercke ◽  
G. Wickart-Johansson ◽  
H. Sjödin ◽  
G. Adell ◽  
J. Nyman ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Stage Iv ◽  
Resected Specimen ◽  
Stage Iv Disease

6040 Background: Concomitant chemoradiotherapy (CT/RT) is the standard treatment for locally advanced head and neck squamous cell carcinoma. However, late toxicity is substantial.This phase II trial explores the feasibility and efficacy of combining neoadjuvant TPF and accelerated RT where the concomitant cytostatic component is replaced with cetuximab (E), a chimeric IgG1 mAb against EGFR. Methods: Patients (pts) had previously untreated stage III/IV M0,WHO 0–1, unresectable squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx and were scheduled for 2 cycles of TPF (docetaxel 75 mg/m2 and cisplatin 75 mg/m2 day 1 and 5-FU 1,000 mg/m2 96 hours CI) every 3 weeks followed by RT (68 Gy/4.5 weeks) with E given one week before (400 mg/m2) and weekly during RT (250 mg/m2). A brachytherapy boost of 8 Gy was given to pts with oral cavity or oropharyngeal tumours. Neck dissection was planned for pts with N2–3 and complete response (CR) at the primary tumour. Tumour response was evaluated according to RECIST with CT, MRI or PET/CT after CT and at 6 weeks follow up. Toxicity (CTC 3.0) and quality of life (EORTC QLQ 30) was registered during and after treatment. Results: From 070401 to 081115 68 pts were enrolled, 56 had stage IV disease (T4, n = 14, N3, n = 9). Median age 57, 60 males, 3 oral cavity, 44 oropharynx, 10 larynx, and 11 hypopharynx. 30 pts were followed beyond 6 weeks and evaluated for response and early toxicity: stage IV disease 24 (T4, n = 6, N3, n = 3), median age 60, 25 males, 18 oropharynx, 5 larynx, and 7 hypopharynx. Remissions after TPF/after RT: CR 1/10, PR 15/18, SD 14/1, and PD 1. TPF as prescribed: 28/30 (pat refusal 1, renal insuff 1, dose reduction 0/28); E as prescribed: 22/30 (dermatitis 4, hypersensitivity 3, liver tox 1). Vital tumour in resected specimen 0/13. Alive at follow-up 29/30 (1 local failure). Conclusions: TPF followed by RT concomitant with E is feasible with manageable toxicities. Dermatitis in the irradiated neck, at least with the present accelerated fractionation, is troublesome to some patients but does not interrupt treatment and heals rapidly. To dispose of feeding tubes after disappearance of acute mucosal reactions has not been a problem. Early survival results are promising. Toxicity and survival results will be updated. [Table: see text]

scholarly journals Role of Depth of Invasion in Evaluation and Management of Early-stage Oral Cavity Squamous Cell Carcinoma

2017 ◽  
Vol 8 (2) ◽  
pp. 84-88
Author(s):  
Bahbak Shariat-Madar ◽  
Jeffrey C Liu
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Early Stage ◽  
Lymph Node Staging ◽  
Depth Of Invasion ◽  
Disease Free

ABSTRACT Aim To evaluate the existing body of literature and impact of depth of invasion (DOI) in early-stage oral cavity squamous cell carcinoma (OCSCC) and its role in predicting occult cervical lymph node metastases. Background The prognosis for early-stage T1 to T2 disease OCSCC is relatively poor compared with other mucosal subsites within the head and neck. Primary tumor DOI can help prognosticate high-risk tumors for additional treatment. Review results There are unequivocal management implications in the literature demonstrating a role for elective neck dissection in early-stage OCSCC based on DOI. Following appropriate patient selection, there may be a role for sentinel lymph node biopsy in regional lymph node staging in early-stage OCSCC. Conclusion There are a multitude of studies demonstrating novel strategies to appropriately treat early-stage OCSCC, which are increasingly becoming standard of care. These strategies are altering the overall and disease-free survival of early-stage OCSCC. Despite advances, locoregional recurrence remains a challenge in this disease. Clinical significance Herein, the authors highlight a number of advances in the management of early-stage OCSCC as described in the literature, which are having an impact on disease-free and overall survival. How to cite this article Shariat-Madar B, Liu JC. Role of Depth of Invasion in Evaluation and Management of Early-stage Oral Cavity Squamous Cell Carcinoma. Int J Head Neck Surg 2017;8(2):84-88.

scholarly journals Pre-operative chemotherapy in locally advanced but technically resectable oral cavity squamous cell carcinoma: a meta-analysis

2016 ◽  
Vol 27 ◽  
pp. iv87
Author(s):  
O. Iocca ◽  
G. Gadaleta-Caldarola ◽  
M. Brandi ◽  
G. Filippelli ◽  
S. Infusino
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Meta Analysis ◽  
Locally Advanced
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