Impact of Postoperative Radiotherapy and Chemotherapy on Survival for Patients with Node Positive Oral Cancer

Mohamed Mahmoud, Tarek Shouman, Hesham Elhosseny, Mona Aboelenin, Mohamed Amin

Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

DOI: 10.4236/jct.2013.411A001                

Abstract

Purpose: The aim of the present study is to compare between the use of post-operative concurrent chemotherapy and radiotherapy alone on survival for patients with high risk oral cavity tumors at the National cancer Institute of Egypt, undergoing surgery and receiving adjuvant treatment. Patients and Methods: This is a retrospective study, which was carried out at the National Cancer Institute (Cairo University) on patients with node positive oral cavity cancer diagnosed between the year 2000 and 2008. The study included 60 patients (45 males and 15 females) with median age 57 years old. The patients underwent surgery, followed by postoperative radiotherapy 60 Gy/6 weeks versus postoperative radiotherapy 60 Gy/6 weeks with concurrent cisplatin 100 mg/m² at day 1, day 22 and day 43. Results: Regarding use of concurrent chemotherapy, there was a significant difference in overall survival rate and locoregional control favoring patients who received concurrent chemotherapy and radiotherapy, 3 years and 5 years overall survival rates respectively were 53.8% and 40.4% compared to 37.5% and 26.3% for patients who didn’t receive any chemotherapy with (p < 0.038) for 5 years. Regarding age, there was a significant difference in overall survival rate favoring patients ≤57 years in both arm groups, 3 years and 5 years overall survival rates respectively were 51.6% and 38.9% compared to 28.3% and 18.9% for patients >57 years with (p < 0.028) for 5 years. Conclusion: We recommend for oral cavity tumor patients at the NCI of Egypt who have positive neck nodes to be treated with concurrent chemo-radiotherapy rather than radiotherapy alone especially by using the new techniques as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT).

Keywords

Concurrent Radiotherapy and Chemotherapy; Intensity Modulated Radiotherapy; Image Guided Radiotherapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. S. Cooper, T. F. Pajak, A. A. Forastiere, et al., “Post-Operative Concurrent Radiotherapy and Chemotherapy in High Risk Squamous Cell Carcinoma of the Head and Neck,” The New England Journal of Medicine, Vol. 350, No. 19, 2004, pp. 1937-1944. http://dx.doi.org/10.1056/NEJMoa032646
[2]	J. Bernier and S. M. Benzten, “Post-Operative Treatment of Locally Advanced Head and Neck Cancers,” In: D. J. Adelstien, Ed., Current Clinical Oncology: Squamous Cell Head and Neck Cancer, Humana Press Inc., Totwa, 2005, pp. 197-210. http://dx.doi.org/10.1007/978-1-59259-938-7_14
[3]	A. Lavaf, E. M. Genden, J. A. Cesaretti, et al., “Adjuvant Radiotherapy Improves Overall Survival for Patients with Lymph Node-Positive Head and Neck Squamous Cell Carcinoma,” Cancer, Vol. 112, No. 3, 2008, pp. 535-543. http://dx.doi.org/10.1002/cncr.23206
[4]	J. Kao, A. Lavaf, M. S. Teng, et al., “Adjuvant Radiotherapy and Survival for Patients with Node-Positive Head and Neck Cancer: An Analysis by Primary Site and Nodal Stage,” International Journal of Radiation Oncology Biology Physics, Vol. 71, No. 2, 2008, pp. 362-370. http://dx.doi.org/10.1016/j. ijrobp.2007.09.058
[5]	R. W. Hinerman, W. M. Mendenhall, C. G. Morris, et al., “Postoperative Irradiation for Squamous Cell Carcinoma of the Oral Cavity: 35-Year Experience,” Head Neck, Vol. 26, No. 11, 2004, pp. 984-994. http://dx.doi.org/10.1002/hed.20091
[6]	V. Sandro, M. B. B. S. Porceddu, F. R. A. N. Z. C. R. Belinda Campbell, M. B. B. S. Danny Rischin, M. B. B. S. F.R.A.C.P., et al., “Post-Operative Chemoradiotherapy for High Risk Head and Neck Squamous Cell,” International Journal of Radiation Oncology Biology Physics, Vol. 60, No. 2, 2004, pp. 365-373. http://dx.doi.org/10.1016/j.ijrobp.2004.03.011
[7]	R. Fietkau, C. Lautenschlger, R. Sauer, J. Dunst, A. Becker, M. Baumann, T. Wendt, K. Grüschow, C. Hess, V. Budach, H. Iro, et al., “Postoperative Concurrent Chemotherapy versus Radiotherapy in High-Risk SCCA of the Head and Neck: Results of the German Phase III Trial ARO 96-3,” Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I, Vol. 24, No. 18S, 2006, p. 5507.
[8]	M. D. Branko Zakotnik, M. D. Marjan Budihna, L. Smid, et al., “Patterns of Failures in Patients with Locally Advanced Head and Neck Cancer Treated Postoperatively with Irradiation or Concomitant Irradiation with Mitomycin D and Bleomycin,” International Journal of Radiation Oncology Biology Physics, Vol. 67, No. 3, 2007, pp. 675-690.