Relevance of positive margins in case of adjuvant therapy of oral cancer

• Published in: International journal of oral and maxillofacial surgery 2004-07, Vol.33 (5), p.447-453
• Main Author: KOVACS, A. F
• Format: Article
• Language: English
• Subjects: adjuvant chemotherapy; adjuvant radiotherapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Chemotherapy, Adjuvant; Chi-Square Distribution; Dentistry; Disease-Free Survival; head and neck neoplasms; Humans; Medical sciences; Middle Aged; Mouth Neoplasms - pathology; Mouth Neoplasms - surgery; multi-modal treatment; Neoadjuvant Therapy; Neoplasm Recurrence, Local - prevention & control; oral surgery; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Otorhinolaryngology. Stomatology; Prognosis; Radiotherapy, Adjuvant; Reoperation; Retrospective Studies; Survival Rate; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2003.10.015

Positive or clean surgical margins are of great prognostic interest in the surgical treatment of oral and oropharyngeal cancer with poor survival of patients burdened with positive margins. The impact of postoperative treatment modalities on the survival of these patients is debated. The relevance of positive margins was investigated in three patient populations (a group treated by surgery only, a group with postoperative polychemotherapy, and a group with a multi-modality treatment comprising postoperative radiation with concurrent chemotherapy) which were compared retrospectively. Patients treated with adjuvant regimens following resection in healthy margins had a survival advantage as compared to the surgery only group possibly due to less local relapses and longer relapse latencies. Overall disease-free survival was better in the groups with adjuvant therapy irrespective of free or positive margins. Survival rates following positive surgical margins were worse in all three groups as compared to the respective subgroups with healthy margins. A second resection in patients with positive margins, executed in the group with postoperative radiation with concurrent chemotherapy, did not result in survival improvement. Therefore, radical resection at initial surgery in healthy and clear margins remains indispensable in multi-modality treatment strategies involving surgery. The combination of healthy margins and adjuvant treatment seems to be most favorable for patient survival.