Postoperative Radiation for Oral Cavity Squamous Cell Carcinoma: The EP. John M. Holland, MD OHSU Radiation Oncology March 19, 2008. The Difference?. EP. Album. Postoperative Radiation for Oral Cavity Squamous Cell Carcinoma. Oral Cavity Cancer is a Surgical Disease
John M. Holland, MD
OHSU Radiation Oncology
March 19, 2008
Oral Cavity Cancer is a Surgical Disease
Use Radiation Postoperatively for Appropriate Patients
RT can be used as primary therapy for small (T1, T2) tumors of the oral cavity.
Floor of Mouth
Best results are with a combination of external beam radiation and brachytherapy
Difficult getting enough dose to primary with brachytherapy while still delivering
adequate dose to the regional nodes IJROBP 1990; 18:1287-92.
Brachytherapy complications: soft tissue necrosis, osteonecrosis
Who needs postop RT?
1) Positive Margins
2) Multiple Nodes
3) Extracapsular Extension
Who needs postop RT?
Less certain indications:
1) Lymphovascular space invasion
2) Perineural spread
3) Single encapsulated node +
4) Thick tumors (Tumors 3-9 mm: 44% node+, 7% local recurrence; >9 mm: 53% subclinical node+, 24% local recurrence Head Neck 2002: 24:513-20)
5) Surgeon Vibe
Ten year follow-up
Improved locoregional control in postoperative RT arm (65%) vs. preop RT (48%, p=0.04)
Trend toward improved survival: 38% vs 33%, p=0.10)
Surgical and radiation therapy complications “similar”. IJROBP 1991;20:21-8.
RTOG 7303 established 60 Gy as postop RT dose
MD Anderson performed prospective randomized trial evaluating RT dose for 240 patients with resected stage III/IV cancers of oral cavity, oropharynx, hypopharynx, larynx
180 cGy fractions
Dose ranged from 52.2 Gy to 68.4 Gy
IJROBP 1993; 26:3-11.
Two large randomized trials evaluating RT with or without cisplatin chemotherapy in high-risk resected head and neck squamous cell cancers.
NEJM 2004; 350:1945-1952
NEJM 2004: 350:1937-1944
High risk features: >2 + nodes, +ECE, + margins (EORTC also included perineural spread and vascular tumor embolism)
Radiation dose: 60 Gy RTOG; 66 Gy EORTC
Cisplatin 100 mg/m2 days 1, 22, 43 both
334 EORTC + 459 RTOG patients (793 total)
26-27% oral cavity primaries
In combined analysis, only patients with +ECE and/or + margins benefited from addition of cisplatin Head Neck 2005; 27: 843-850
RTOG 0234 evaluated postop chemoRT (cisplatin or docetaxel) + EGFR inhibitor cetuximab (Erbitux)
This phase II study completed but results are pending
Three-Way Tie for Last