A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy

J. Brown, T. Blackburn, J. Woolgar, D. Lowe, R. Errington, E. Vaughan, S. Rogers

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Abstract

Controversy remains about which patients at intermediate risk of recurrence of oral squamous cell carcinoma would benefit from radiotherapy. A retrospective review of computerised database and medical records for 462 consecutive patients at the Regional Maxillofacial Unit in Liverpool who were treated with primary surgery with or without post-operative radiotherapy was carried out. We classified 29% (134) of patients as being at ‘low’ risk of disease recurrence (pT1-2, N0 with clear margins), 29% (135) at ‘high’ risk (involved margins or lymph node extracapsular spread) and the remaining 42% (193) at ‘intermediate’ risk. Of those at intermediate risk, 41% (80/193) received adjuvant radiotherapy and their 5 year survival (SE) was 54% (6%) compared to 71% (5%) for those with primary surgery alone (P = 0.002). A higher proportion of patients having radiotherapy had loco-regional recurrence (19/80 24%) compared to those treated by surgery alone (17/113 15%). The improved salvage rate for recurrent disease in the surgery alone group (8/17 53%), compared to those receiving radiotherapy (2/19 13%, P = 0.05), indicates an advantage in withholding radiotherapy for patients at intermediate risk of recurrence. This study indicates a potential disadvantage associated with the use of postoperative radiotherapy for patients at intermediate risk of recurrence. A randomised trial comparing a watch and wait policy to postoperative radiotherapy in patients with an intermediate risk of recurrence is required to confirm the trend indicated in this retrospective data
Original languageEnglish
Pages (from-to)764-773
JournalOral Oncology
Volume43
Issue number8
DOIs
Publication statusPublished - Sep 2007

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Squamous Cell Carcinoma
Radiotherapy
Recurrence
Computerized Medical Records Systems
Adjuvant Radiotherapy
Lymph Nodes
Databases
Survival

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Brown, J. ; Blackburn, T. ; Woolgar, J. ; Lowe, D. ; Errington, R. ; Vaughan, E. ; Rogers, S. / A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy. In: Oral Oncology. 2007 ; Vol. 43, No. 8. pp. 764-773.
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A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy. / Brown, J.; Blackburn, T.; Woolgar, J.; Lowe, D.; Errington, R.; Vaughan, E.; Rogers, S.

In: Oral Oncology, Vol. 43, No. 8, 09.2007, p. 764-773.

Research output: Contribution to journalArticle

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T1 - A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy

AU - Brown, J.

AU - Blackburn, T.

AU - Woolgar, J.

AU - Lowe, D.

AU - Errington, R.

AU - Vaughan, E.

AU - Rogers, S.

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AB - Controversy remains about which patients at intermediate risk of recurrence of oral squamous cell carcinoma would benefit from radiotherapy. A retrospective review of computerised database and medical records for 462 consecutive patients at the Regional Maxillofacial Unit in Liverpool who were treated with primary surgery with or without post-operative radiotherapy was carried out. We classified 29% (134) of patients as being at ‘low’ risk of disease recurrence (pT1-2, N0 with clear margins), 29% (135) at ‘high’ risk (involved margins or lymph node extracapsular spread) and the remaining 42% (193) at ‘intermediate’ risk. Of those at intermediate risk, 41% (80/193) received adjuvant radiotherapy and their 5 year survival (SE) was 54% (6%) compared to 71% (5%) for those with primary surgery alone (P = 0.002). A higher proportion of patients having radiotherapy had loco-regional recurrence (19/80 24%) compared to those treated by surgery alone (17/113 15%). The improved salvage rate for recurrent disease in the surgery alone group (8/17 53%), compared to those receiving radiotherapy (2/19 13%, P = 0.05), indicates an advantage in withholding radiotherapy for patients at intermediate risk of recurrence. This study indicates a potential disadvantage associated with the use of postoperative radiotherapy for patients at intermediate risk of recurrence. A randomised trial comparing a watch and wait policy to postoperative radiotherapy in patients with an intermediate risk of recurrence is required to confirm the trend indicated in this retrospective data

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