Early Clinical Stage of Recurrent Squamous Cell Carcinoma of the Mouth and Oropharynx Is a Significant Prognostic Factor for Salvage Surgery: Presented at AAO-HNSF

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Title: Early Clinical Stage of Recurrent Squamous Cell Carcinoma of the Mouth and Oropharynx Is a Significant Prognostic Factor for Salvage Surgery: Presented at AAO-HNSF
URL: http://www.pslgroup.com/dg/22D536.htm
Doctor's Guide
September 23, 2008

By Mary Beth Nierengarten

CHICAGO -- September 23, 2008 -- For patients with squamous cell carcinoma of the upper airways and digestive system being treated with curative intent, early clinical stage of the locoregional recurrence is one of the most significant prognostic factors associated with salvage therapy, according to results of a study presented at the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO.

"Early clinical stage of recurrence enables a higher likelihood of indication for salvage treatment," said lead author Helma Maria Chedid, MD, Department of Head and Neck Surgery and Otolaryngology, Hospital Heliopolis, São Paulo, Brazil, who presented the study on September 21.

"If locoregional recurrence is identified at an early stage, salvage surgery is undoubtedly the first-choice treatment," Dr. Chedid said.

To identify prognostic factors for salvage surgery and assess the disease-free survival interval after salvage treatment for recurrent squamous cell carcinoma of the mouth and oropharynx, Dr. Chedid and colleagues retrospectively examined 127 patients treated with surgery for carcinoma of the oral cavity (n = 90) or oropharynx (n = 37).

In the study, all patients were initially treated with surgical curative intent and had a histological confirmation of locoregional squamous cell carcinoma recurrence. Postoperative radiotherapy was given to 53 patients at a mean dose of 59.8 Gy.

After an average follow-up period of 35.3 months, 76 of the 127 patients underwent salvage surgery, with 22 also receiving postoperative radiotherapy and 13 receiving only salvage chemoradiotherapy. Of the 127 patients, 25 had clinical stage I disease, 11 had stage II disease, 16 had stage III disease, and 71 had stage IV disease.

Salvage therapy involved the mouth in 65% of patients owing to the higher predominance recurrence in that region.

The main indication for salvage surgery was early clinical stage of locoregional recurrence. Significantly more patients with clinical stage I/II recurrent disease received salvage surgery compared with those who did not (33 vs 3, P = .0001).

Other factors also independently associated with receiving salvage surgery on univariate analysis were the site of tumour recurrence, initial clinical stage, and previous radiotherapy. On multivariate analysis, clinical stage of locoregional recurrence, site of primary tumour, and previous radiotherapy remained independent clinical prognostic factors.

The study also found that disease-free survival after salvage was significantly associated with time to recurrence. Disease-free survival was 13% for patients with recurrence within 6 months, 40% for those with recurrence between 6 and 12 months, and 48% for those with recurrence >12 months after treatment (P = .0001).

Based on these results, Dr. Chedid emphasised the need to perform outpatient consultations every month during the initial 18 months after treatment and then bimonthly up to the third year. After that, she suggested follow-up every 3 months up to 5 years and every 6 months thereafter.

"Follow-up for patients with squamous cell carcinoma is of fundamental importance," said Dr. Chedid. "Emphasis has been placed on disease with early clinical stage, as this is considered to be a priority for a rapid approach [to treatment]."

[Presentation title: Prognostic Factors in Salvage Surgery. Poster R407]

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