Moderate severe dysplasia at resection margin may warrant additional therapy

Moderate or severe dysplasia at the resection margin correlated with inferior local control and DFS among patients with low-risk oral tongue cancer, according to results of a retrospective analysis.

The findings suggest additional therapy may be warranted in those patients, despite the potential for morbidity, researchers said.

Thomas Galloway, MD, of the department of radiation oncology at Fox Chase Cancer Center in Philadelphia, and colleagues evaluated 126 patients with T1-2N0 oral tongue cancer who underwent surgery between 1990 an 2010.

Galloway and colleagues determined 36% of patients presented with dysplasia at the final margin. Of these cases, 9% were severe, 15% were moderate and 12% were mild.

Median follow-up was 52 months.

Local control rates were 77% at 3 years and 73% at 5 years.

Actuarial 5-year local control was significantly worse in patients with moderate or severe dysplasia at the margin compared with those with mild dysplasia at the margin (49% vs. 82%; P=.005). Five-year DFS also was significantly worse for patients with moderate or severe dysplasia at the margin (49% vs. 80%; P=.008).

The differences at 3 years were not statistically significant.

In individual analyses, moderate dysplasia at the margin had a significant detrimental local effect (P=.02). The effect of severe dysplasia approached significance (P=.1).

Mild dysplasia at the margin did not significantly affect local control or DFS.

Results of multivariate analysis showed severe or moderate dysplasia at the margin was associated with worse local control (HR=2.99; P=.006) and DFS (HR=2.84; P=.008).

“The results of this study indicate that moderate dysplasia at the margin of an oral tongue cancer resection should be managed similarly to severe dysplasia,” Galloway told HemOnc Today.  “That is, it should be resected during the initial surgical procedure, if possible.  By contrast, it appears that mild dysplasia at the margin does not warrant further treatment.”

Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.