Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience

Corey C. Foster, James M. Melotek, Ryan J. Brisson, Tanguy Lim Seiwert, Ezra E.W. Cohen, Kerstin M. Stenson, Elizabeth A. Blair, Louis Portugal, Zhen Gooi, Nishant Agrawal, Everett E. Vokes, Daniel J. Haraf

Research output: Contribution to journalArticle

Abstract

Objectives: Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. Materials and Methods: Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. Results: 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. Conclusion: Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.

Original languageEnglish (US)
Pages (from-to)16-22
Number of pages7
JournalOral Oncology
Volume80
DOIs
StatePublished - May 1 2018
Externally publishedYes

Fingerprint

Mouth Neoplasms
Osteoradionecrosis
Mouth
Squamous Cell Carcinoma
Disease-Free Survival
Survival
Organ Preservation
Mouth Floor
Intensity-Modulated Radiotherapy
Hydroxyurea
Enteral Nutrition
Chi-Square Distribution
Tongue
Fluorouracil
Radiotherapy
Therapeutics
Drug Therapy

Keywords

  • Chemoradiotherapy
  • Head and neck neoplasms
  • Neoplasms
  • Osteoradionecrosis
  • Squamous cell
  • Tongue neoplasms

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Foster, C. C., Melotek, J. M., Brisson, R. J., Lim Seiwert, T., Cohen, E. E. W., Stenson, K. M., ... Haraf, D. J. (2018). Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience. Oral Oncology, 80, 16-22. https://doi.org/10.1016/j.oraloncology.2018.03.008

Definitive chemoradiation for locally-advanced oral cavity cancer : A 20-year experience. / Foster, Corey C.; Melotek, James M.; Brisson, Ryan J.; Lim Seiwert, Tanguy; Cohen, Ezra E.W.; Stenson, Kerstin M.; Blair, Elizabeth A.; Portugal, Louis; Gooi, Zhen; Agrawal, Nishant; Vokes, Everett E.; Haraf, Daniel J.

In: Oral Oncology, Vol. 80, 01.05.2018, p. 16-22.

Research output: Contribution to journalArticle

Foster, CC, Melotek, JM, Brisson, RJ, Lim Seiwert, T, Cohen, EEW, Stenson, KM, Blair, EA, Portugal, L, Gooi, Z, Agrawal, N, Vokes, EE & Haraf, DJ 2018, 'Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience', Oral Oncology, vol. 80, pp. 16-22. https://doi.org/10.1016/j.oraloncology.2018.03.008
Foster, Corey C. ; Melotek, James M. ; Brisson, Ryan J. ; Lim Seiwert, Tanguy ; Cohen, Ezra E.W. ; Stenson, Kerstin M. ; Blair, Elizabeth A. ; Portugal, Louis ; Gooi, Zhen ; Agrawal, Nishant ; Vokes, Everett E. ; Haraf, Daniel J. / Definitive chemoradiation for locally-advanced oral cavity cancer : A 20-year experience. In: Oral Oncology. 2018 ; Vol. 80. pp. 16-22.
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abstract = "Objectives: Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. Materials and Methods: Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. Results: 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7{\%} had T3/T4 disease, 68.6{\%} had ≥N2 nodal disease, and 91.4{\%} had stage IV disease. Most common primary sites were oral tongue (47.9{\%}) and floor of mouth (24.3{\%}). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2{\%}, 58.7{\%}, 78.6{\%}, and 87.2{\%}, respectively. Rates of ORN and long-term feeding tube dependence were 20.7{\%} and 10.0{\%}, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. Conclusion: Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.",
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AU - Foster, Corey C.

AU - Melotek, James M.

AU - Brisson, Ryan J.

AU - Lim Seiwert, Tanguy

AU - Cohen, Ezra E.W.

AU - Stenson, Kerstin M.

AU - Blair, Elizabeth A.

AU - Portugal, Louis

AU - Gooi, Zhen

AU - Agrawal, Nishant

AU - Vokes, Everett E.

AU - Haraf, Daniel J.

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N2 - Objectives: Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. Materials and Methods: Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. Results: 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. Conclusion: Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.

AB - Objectives: Definitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC. Materials and Methods: Patients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test. Results: 140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades. Conclusion: Definitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.

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KW - Head and neck neoplasms

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