Tumor control and survival after postoperative radiotherapy for high-risk oral cavity cancer: A retrospective cohort study

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-05-30 DOI:10.1016/j.ctro.2025.100988

Pepijn B Bolleurs , Brend P Jonker , Joris BW Elbers , Gerda M Verduijn , Atilla Gül , Aniel Sewnaik , Wilma D Heemsbergen

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Abstract

Background

We evaluated locoregional failure (LRF) and survival after postoperative radiotherapy (PORT) in selected high-risk oral squamous cell carcinoma (OSCC) patients.

Methods

In a retrospective OSCC cohort (n = 219) treated with local (n = 216) and/or regional (n = 87) PORT in 2011–2018, we determined the first location of tumor recurrence or progression, survival, and cause of death. Tumor control and survival was calculated using Kaplan Meier method. Prognostic factors were evaluated in Cox regression models.

Results

Main subsites were oral tongue (34 %), gingiva (32 %), and floor of mouth (27 %). Eight percent also received chemotherapy. Median follow-up was five year for tumor control and eight year for survival. Tumor progression was observed in 47 patients (n = 31 LRF). Nine patients had salvage treatment. Locoregional control was 87 % and 84 % at 2 and 5 years, respectively. Significant prognostic factors for local failure (LF) were T4 stage, bone invasion, and subsite gingiva; 12 of 18 LF concerned a T4 gingiva tumor with bone invasion. For regional failure (RF), pN1 (vs pN0) was prognostic, mainly concerning solitary contralateral RFs. Overall survival was 63 % and 48 % at 5 and 8 year, respectively. Main causes of death (104 events) were the index tumor (n = 42) and a post-treatment second primary tumor (n = 37).

Conclusion

A locoregional control of 84 % was achieved after PORT for high-risk OSCC with only 8 % receiving additional chemotherapy. Overall survival was 48 % at 8 years, with a large proportion of cancer-related deaths related to the index tumor and other subsequent tumor diagnoses. Risk of LF was increased for gingiva tumors with bone invasion. N1 stage was associated with a risk of solitary contralateral RFs in non-irradiated neck areas.

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高危口腔癌术后放疗后肿瘤控制与生存：一项回顾性队列研究

本研究评估了高危口腔鳞状细胞癌（OSCC）患者术后放疗（PORT）后的局部失败（LRF）和生存率。方法在2011-2018年接受局部（n = 216）和/或区域（n = 87） PORT治疗的OSCC回顾性队列（n = 219）中，我们确定了肿瘤复发或进展的第一位置、生存期和死亡原因。采用Kaplan Meier法计算肿瘤控制及生存期。采用Cox回归模型评估预后因素。结果口腔舌部（34%）、龈部（32%）、口腔底部（27%）是口腔感染的主要部位。8%的人还接受了化疗。肿瘤控制的中位随访为5年，生存的中位随访为8年。47例患者（n = 31 LRF）观察到肿瘤进展。9例患者接受了抢救治疗。2年和5年的局部控制率分别为87%和84%。局部功能衰竭（LF）的重要预后因素为T4期、骨侵犯和龈亚位；18例LF中有12例涉及T4牙龈肿瘤伴骨侵犯。对于局部衰竭（RF）， pN1 （vs pN0）是预后因素，主要与孤立的对侧RF有关。5年和8年的总生存率分别为63%和48%。主要死亡原因（104例）为指数肿瘤（n = 42）和治疗后第二原发肿瘤（n = 37）。结论高危OSCC PORT术后局部控制率为84%，仅8%的患者接受了额外的化疗。8年总生存率为48%，大部分癌症相关死亡与指标肿瘤和其他后续肿瘤诊断相关。伴有骨侵犯的牙龈肿瘤发生LF的风险增加。N1期与未放疗颈部单发对侧RFs的风险相关。

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