Adjuvant radiotherapy after curative surgery for oral cavity squamous cell carcinoma and treatment effect of timing and duration on outcome-A Taiwan Cancer Registry national database analysis

Yung-Jen Cheng; Mu-Hung Tsai; Chun-Ju Chiang; Sen-Tien Tsai; Tsang-Wu Liu; Pei-Jen Lou; Chun-Ta Liao; Jin-Ching Lin; Joseph Tung-Chieh Chang; Ming-Hsui Tsai; Pen-Yuan Chu; Yi-Shing Leu; Kuo-Yang Tsai; Shyuang-Der Terng; Chih-Yen Chien; Muh-Hwa Yang; Sheng-Po Hao; Chuan-Cheng Wang; Ming-Hsun Tsai; Helen H W Chen; Chin Kuo; Yuan-Hua Wu

doi:10.1002/cam4.1611

Adjuvant radiotherapy after curative surgery for oral cavity squamous cell carcinoma and treatment effect of timing and duration on outcome-A Taiwan Cancer Registry national database analysis

Cancer Med. 2018 Jul;7(7):3073-3083. doi: 10.1002/cam4.1611. Epub 2018 Jun 14.

Authors

Yung-Jen Cheng¹, Mu-Hung Tsai¹, Chun-Ju Chiang^{2

3}, Sen-Tien Tsai^{1

4}, Tsang-Wu Liu⁵, Pei-Jen Lou⁶, Chun-Ta Liao⁷, Jin-Ching Lin⁸, Joseph Tung-Chieh Chang⁹, Ming-Hsui Tsai¹⁰, Pen-Yuan Chu¹¹, Yi-Shing Leu¹², Kuo-Yang Tsai¹³, Shyuang-Der Terng¹⁴, Chih-Yen Chien¹⁵, Muh-Hwa Yang¹⁶, Sheng-Po Hao¹⁷, Chuan-Cheng Wang¹⁸, Ming-Hsun Tsai^{2

3}, Helen H W Chen¹, Chin Kuo¹, Yuan-Hua Wu¹

Affiliations

¹ Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ Taiwan Cancer Registry, Taipei, Taiwan.
⁴ Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan.
⁶ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
⁸ Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Department of Radiation Oncology, Head and Neck Oncology Group, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
¹⁰ Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
¹¹ Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.
¹² Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
¹³ Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
¹⁴ Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
¹⁵ Department of Otolaryngology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
¹⁶ Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁷ Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
¹⁸ Division of Medical Oncology in the Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.

Abstract

Conduct an accurate risk assessment of resected oral cavity squamous cell carcinoma (OSCC) patients by accessing a nationwide systemic investigation is pivotal to improve treatment outcomes. In this article, we tried to determine the impact of different prognostic factors for OSCC patients who received adjuvant radiotherapy (RT) after curative surgery, using Taiwan's national cancer registry database (TCR). A nationwide, large population-based study was conducted using TCR with patients identified from 2007 to 2015. The study variables included age, gender, cancer subsites, stage, histology grade, margin and extra-nodal extension (ENE) status, treatment type, surgery to RT interval (ORI), total RT treatment time (RTT), and RT dose. Univariate and multivariate analysis were performed to identify predictors of the variables associated with overall survival (OS), cause-specific survival (CSS), local-regional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS). 8986 OSCC patients treated with surgery and adjuvant RT were analyzed. In multivariate analysis, worse outcomes were associated with males, older age, subsite in the oral tongue, advanced stage, higher histologic grade, involved margin, and positive ENE. ORI only showed an adverse trend in LRFS, when exceeding 7 weeks (P = .06). RTT >8 weeks was a significant poor predictor in OS, CSS and LRFS (P < .001). Extreme RT dose (>70 Gy or ≤50 Gy) also demonstrated an adverse impact on the outcomes. Prolonged RT treatment time and extreme RT doses were identified as significantly poor prognostic predictors in OSCC patients who received adjuvant RT after curative surgery.

Keywords: adjuvant radiotherapy; cancer database; oral cancer; prognostic factor; treatment time.

Abstract

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