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Novel surgical approach improves local recurrence rates in oral cancers
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The use of fluorescence visualization-guided surgery appeared to reduce local recurrence rates among patients with preinvasive high-grade and early-stage oral cancers, according to retrospective study results.
“Genetically altered cells are often widespread across the oral mucosa of patients with squamous cell carcinoma, which presents as low-grade disease or normal tissue clinically and histologically,” Catherine F. Poh, DDS, PhD, associate professor of dentistry at University of British Columbia and clinical scientist in the Integrative Oncology and Cancer Control Research Program at BC Cancer Research Centre in Vancouver, British Columbia, and colleagues wrote. “Development of new approaches that can be adopted easily in clinical settings to facilitate the detection of clinically occult fields with a high risk for oral cancer remain a pressing need.”
Fluorescence visualization (FV) can aid in the identification of high-risk oral lesions, thus allowing clinicians to visualize and map occult disease, according to study background.
Thus, Poh and colleagues sought to validate FV–guided surgery as an effective strategy for the reduction of locoregional recurrence and improvement of OS in patients with oral cancers.
The researchers reviewed data from 246 patients (mean age, 60 ± 12 years; 56.1% men) who received treatment at an oral oncology clinic between September 2004 and August 2009. All patients underwent curative surgery for a high-grade oral lesion or squamous cell carcinoma smaller than 4 cm, with at least one follow-up visit. Ninety patients had high-grade lesions and 156 patients had squamous cell carcinoma.
Key study objectives included local recurrence of oral lesions with a histologic grade of severe dysplasia or higher, the presence of regional failure, and DFS after surgery.
Surgical options included FV–guided surgery (n = 154) and conventional surgical treatment (n = 92). The researchers did not observe significant differences in age, smoking history, anatomical lesion site, tumor size or previous oral cancer between groups.
Among patients with squamous cell carcinoma, the rate of 3-year local recurrence appeared significantly lower among those treated with FV–guided surgery (n = 92) compared with those treated with conventional surgery (n = 64; 6.5% vs. 40.6%; P < .001).
Similarly, a smaller proportion of patients with high-grade lesions who underwent FV–guided surgery (n = 62) experienced local recurrence than patients who underwent conventional surgery (n = 28; 8.1% vs. 39.3%; P < .001).
Compared with those who underwent conventional surgical approaches, a smaller proportion of patients with squamous cell carcinoma treated with FV–guided surgery experienced regional failure (15.2% vs. 25%) and died (13% vs. 20.3%). However, these differences did not reach statistical significance.
Results of a multivariate analysis of patients with squamous cell carcinoma showed the association with FV–guided surgery and reduction in local recurrence persisted (HR = 0.16; 95% CI, 0.06-0.39), whereas older age increased risk for local recurrence (HR 1.05; 95% CI, 1.02-1.08).
Further, having a previous cancer increased risk for regional failure (HR = 5.51; 95% CI, 1.79-17).
Among patients with high-grade lesions, FV–guided surgery reduced risk for recurrence (HR = 0.16; 95% CI, 0.05-0.51), whereas having a previous cancer increased recurrence risk (HR = 2.99; 95% CI, 1.05-8.52).
The researchers acknowledged the potential for selection bias as a study limitation. However, they reported that the FV–guided surgical approach is being investigated in the ongoing multicenter, phase 3 Canadian Optically Guided Research for Oral Lesions Surgical (COOLS) Trial.
“If validated in the COOLS trial, level one evidence will support this novel approach to be implemented in the clinical setting to change practice and, subsequently, improve patients’ outcomes,” Poh and colleagues wrote. – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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