© The Author (2008). Published by Oxford University Press. All rights reserved
Treatment of Patients with Clinically Lymph Node-negative Squamous Cell Carcinoma of the Oral Cavity
1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul
2 Department of Otolaryngology and Head and Neck Surgery, Seoul National University College of Medicine, Seoul
3 Department of Oral and Maxillofacial Surgery, Seoul National University College of Dentistry, Seoul
4 Cancer Research Institute, Seoul National University College of Medicine, Seoul
5 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
For reprints and all correspondence: Hong-Gyun Wu, Department of Radiation Oncology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea. E-mail: wuhg{at}snu.ac.kr
Received April 3, 2008; accepted May 17, 2008
Objective: To evaluate treatment outcome and to determine optimal treatment strategy for patients with clinically lymph node-negative (N0) oral cavity squamous cell carcinoma (SCC).
Methods: Two hundred and twenty-seven patients with oral cavity SCC received radiotherapy with curative intent. We retrospectively analyzed 69 patients with clinically N0 disease. Forty-three patients were treated with surgery followed by radiotherapy (S+EBRT) and 26 with radiotherapy alone (EBRT). The median doses administered were 63.0 Gy for S+EBRT and 70.2 Gy for EBRT.
Results: The rates of occult metastasis were 60% for T1, 69% for T2, 100% for T3 and 39% for T4, respectively, among patients who underwent neck dissection. A contralateral occult metastasis occurred only in two patients. The median follow-up was 39 months (range, 6–170 months). The 5-year overall survival (OS), disease-free survival (DFS), local control (LC) and regional control (RC) rates for all patients were 56, 50, 66 and 79%, respectively. The 5-year OS, DFS, LC and RC rates were 67/39% (P < 0.01), 66/24% (P < 0.01), 87/30% (P < 0.01) and 73/89% (P = 0.11) for S+EBRT/EBRT, respectively.
Conclusions: The risk for occult neck metastasis is high in patients with oral cavity SCC; therefore, elective neck treatment should be considered. Excellent RC for subclinical disease can be achieved with radiotherapy alone. However, external beam radiotherapy alone to primary tumor resulted in poor LC and combined treatment with surgery and radiotherapy appeared to be a better treatment strategy.
Key Words: oral cavity cancer • squamous cell carcinoma • lymph node-negative • radiotherapy • surgery
Presented as a poster at the ASTRO'S 49th Annula Meeting, October 28–November 1, 2007, Los Angeles, CA, USA.