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Surgery plus radiation improves outcomes in oral cavity, maxillary sinus cancers
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Patients with cancers of the oral cavity or maxillary sinus who underwent primary surgery and adjuvant radiation therapy demonstrated superior outcomes compared with those who received concurrent chemotherapy and radiation therapy, according to long-term study results.
However, the two modalities of treatment conferred similar outcomes in patients with head and neck squamous cell carcinoma at other subsites, results showed.
N. Gopalakrishna Iyer, MD, PhD, of the department of surgical oncology at National Cancer Centre Singapore, and colleagues evaluated data from 119 patients with stage III/IV nonmetastatic HNSCC.
Researchers assigned 60 patients to primary surgery plus adjuvant radiation. The other 59 patients received concurrent chemotherapy and radiation therapy. Forty-one patients in the chemoradiotherapy arm and 50 in the surgery arm underwent treatment according to the study protocol.
Ninety-two patients had died by the time of the analysis. Median follow-up for surviving patients was 13 years (range, 0.5-14).
Overall, a similar proportion of patients in the surgery and chemoradiotherapy arms achieved 5-year OS (45% vs. 35%; P = .26) and 5-year disease-specific survival (56% vs. 46%; P = .63).
Patients in the surgery and chemoradiotherapy arms also demonstrated similar rates of locoregional RFS (P = .46) and distant RFS (P = .13).
Researchers then conducted disease subsite analyses to determine why the difference in OS and disease-specific survival tended to favor the surgery arm.
Patients with oral cavity cancer who underwent surgery experienced longer 5-year disease-specific survival than patients in the chemoradiotherapy arm (68% vs. 12%; P = .03). Surgery and adjuvant radiation also were associated with improved distant RFS (92% vs. 50%; P = .05); however, the rates for locoregional DFS did not significantly differ between the treatment modalities (P = .35).
Patients with maxillary sinus cancers demonstrated a significant benefit from surgery and adjuvant radiation with regard to disease-specific survival (71% vs. 0%; P = .05) and locoregional DFS (86% vs. 0%; P = .05).
However, researchers did not observe a difference in outcomes between the two arms among patients with oropharynx, larynx and hypopharynx cancers.
“Although treatment outcomes are comparable between patients treated with chemoradiotherapy and those treated with surgery followed by adjuvant radiation therapy, there are risks and benefits to each treatment modality,” Iyer and colleagues concluded. “Chemoradiotherapy is an acceptable option in selected groups of patients with oropharyngeal, laryngeal and hypopharyngeal disease sites with the view of organ preservation without compromising survival. This option should not be recommended for patients with tumors in other sites except within the context of unresectability. Although often disfiguring with resultant compromise of upper aerodigestive tract function, surgery and adjuvant radiation therapy with the addition of concurrent cisplatin in the presence of high-risk pathological features (positive survival resection margins and/or extranodal extension) remains the standard of care in these other sites.”
Disclosure: The researchers report no relevant financial disclosures.
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