Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma

Gunnar Wichmann; Mykola Pavlychenko; Maria Willner; Dirk Halama; Thomas Kuhnt; Regine Kluge; Tanja Gradistanac; Sandra Fest; Theresa Wald; Bernd Lethaus; Andreas Dietz; Susanne Wiegand; Veit Zebralla

doi:10.3389/fonc.2021.737080

Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma

Front Oncol. 2021 Nov 10:11:737080. doi: 10.3389/fonc.2021.737080. eCollection 2021.

Authors

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany.
² Department of Maxillofacial Surgery, University Hospital Leipzig, Leipzig, Germany.
³ Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany.
⁴ Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
⁵ Department of Pathology, University Hospital Leipzig, Leipzig, Germany.

Abstract

Background: Standardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III-IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.

Methods: As MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.

Results: Most patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.

Conclusions: Despite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.

Keywords: distant metastasis free survival (DMFS); elective neck dissection (ND); head and neck cancer; local control (LC); multidisciplinary tumor board (MDTB); oral squamous cell carcinoma (OSCC); outcome research; overall survival (OS).