Neoadjuvant and adjuvant therapy in patients with oral squamous cell carcinoma: Long-term survival in a prospective, non-randomized study
Introduction
Today the treatment of primary oral squamous cell carcinomas (SCC) includes various combinations of radiotherapy, chemotherapy and surgery.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 The main goal of any kind of combined treatment in carcinomas of the oral cavity is to guarantee long tumour-free survival with as little loss of function as possible. Any mutilation of the patient should be avoided. As well as function, the aesthetic result of any treatment in this area must be acceptable.7, 8, 9, 11, 12, 13, 14 From the surgical point of view different strategies are possible: the choices include resection of the tumour after a preoperative course of radiotherapy or radiochemotherapy. Adjuvant treatment is the standard treatment based on resection followed by radiotherapy or radiochemotherapy. The extent of the resection can be influenced by the level of radiation and the treatments may be based on preoperative doses of radiation between 35 and 63 Gy.7, 9, 12, 14, 15, 16
In neoadjuvant treatment of oral SCC free flap and microvascular procedures are essential for the reconstruction after resection of the tumour.7, 9, 12, 14 For the treatment to be considered successful, the side effects should not reduce the quality of life of these patients more than necessary. This means that short-term and long-term effects such as the development of osteoradionecrosis (particularly in the mandible) must be considered when planning the treatment.14
The aim of this study was to discuss the 5-year survival rate in a neoadjuvant and an adjuvant combination treatment in patients with primary oral SCC. The data were gathered prospectively in a non-randomised study. It is not ethical to compare randomised, evidence-based results with standard treatment in patients with oral SCC.
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Patients and methods
From January 1997 until March 2005, a total of 128 patients with primary SCC of the oral cavity that had not been treated previously were included in the study. Seventeen were female and 111 male. The mean age on admission to hospital was 58 years (range 33–77). Seventy-one patients had SCC of the floor of the mouth and 25 carcinoma of the tongue. In 32 patients, the alveolar process including the retromolar region of the mandible was affected (Table 1). Heavy smoking and alcohol misuse, which
Results
The cumulative survival rate for all T-categories was 72% for patients in the neoadjuvant group and 56% for those in the adjuvant group (Fig. 1). The survival rate was 83.1% for T1 tumours in the neoadjuvant group and 70.1% in the adjuvant group. In T2 tumours it was 79.6% for the neoadjuvant group and 57.7% for the adjuvant group. InT3 and T4 tumours the figures were 68.2% and 33.2%, and 51.4% and 30.5%, in favour of the neoadjuvant treatment. For the T-categories the results were confirmed by
Discussion
During the past 30 years relevant progress in the treatment of oral SCC has been achieved by introducing multidisciplinary treatment and by developing microvascular techniques for free flap reconstruction.7, 9 The combination of different treatments has the advantage that the effectiveness of each one can be limited to preserve as much function and cosmesis as possible.1, 10, 17 However, there are certain limitations: unfortunately patients with oral SCC are referred to the clinic with a poor
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