Steven B Chinn1, Matthew E Spector1, Emily L Bellile2, Laura S Rozek3, Tasha Lin1, Theodoros N Teknos4, Mark E Prince5, Carol R Bradford5, Susan G Urba6, Thomas E Carey5, Avraham Eisbruch7, Gregory T Wolf5, Francis P Worden6, Douglas B Chepeha5. 1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor. 2. Comprehensive Cancer Center Biostatistics Unit, University of Michigan, Ann Arbor. 3. Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor. 4. Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor4now with Department of Otolaryngology-Head and Neck Surgery, Ohio State University Medical Center, Columbus. 5. Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor. 6. Comprehensive Cancer Center, University of Michigan, Ann Arbor6Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor. 7. Comprehensive Cancer Center, University of Michigan, Ann Arbor7Department of Radiation Oncology, University of Michigan, Ann Arbor.
Abstract
IMPORTANCE: The University of Michigan has investigated the use of induction selection (IS) with chemoradiotherapy (CRT) for patients who respond to CRT and found this approach effective in the management of advanced laryngeal cancer. The IS approach was extended to oral cavity squamous cell carcinoma (OCSCC) to help understand whether organ preservation or survival benefit resulted. OBJECTIVE: To evaluate the efficacy of an IS protocol vs primary surgical extirpation and selective postoperative radiotherapy for advanced OCSCC. DESIGN AND SETTING: Retrospective matched cohort study at a tertiary care hospital. PARTICIPANTS: Nineteen patients with resectable stages III and IV OCSCC were enrolled into a phase 2 IS trial. Patients with a response of at least 50% underwent concurrent CRT; those with a response of less than 50% underwent surgical treatment and radiotherapy. A comparison cohort of patients treated with primary surgical extirpation during a similar time period was frequency matched for inclusion criteria and patient characteristics to those patients included from the phase 2 IS trial. No difference was noted in age, sex, pretreatment American Joint Committee on Cancer stage, T and N classifications, smoking status, alcohol consumption, or tumor subsite between the IS and surgical cohorts. Median follow-up was 9.4 years in the IS cohort and 7.1 years in the surgical cohort. INTERVENTIONS: Induction selection and CRT vs primary surgical extirpation with or without postoperative radiotherapy. MAIN OUTCOMES AND MEASURES: Overall and disease-specific survival and locoregional control. RESULTS: The Kaplan-Meier estimate for overall survival at 5 years was 32% in the IS cohort and 65% in the surgical cohort. The Kaplan-Meier estimate for disease-specific survival at 5 years was 46% in the IS cohort and 75% in the surgical cohort. The Kaplan-Meier estimate for locoregional control at 5 years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better overall and disease-specific survival and locoregional control outcomes (P = .03, P = .001, and P < .001, respectively) in the surgical cohort. CONCLUSIONS AND RELEVANCE: Primary surgical treatment showed significantly better survival and locoregional control compared with IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol vs primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.
IMPORTANCE: The University of Michigan has investigated the use of induction selection (IS) with chemoradiotherapy (CRT) for patients who respond to CRT and found this approach effective in the management of advanced laryngeal cancer. The IS approach was extended to oral cavity squamous cell carcinoma (OCSCC) to help understand whether organ preservation or survival benefit resulted. OBJECTIVE: To evaluate the efficacy of an IS protocol vs primary surgical extirpation and selective postoperative radiotherapy for advanced OCSCC. DESIGN AND SETTING: Retrospective matched cohort study at a tertiary care hospital. PARTICIPANTS: Nineteen patients with resectable stages III and IV OCSCC were enrolled into a phase 2 IS trial. Patients with a response of at least 50% underwent concurrent CRT; those with a response of less than 50% underwent surgical treatment and radiotherapy. A comparison cohort of patients treated with primary surgical extirpation during a similar time period was frequency matched for inclusion criteria and patient characteristics to those patients included from the phase 2 IS trial. No difference was noted in age, sex, pretreatment American Joint Committee on Cancer stage, T and N classifications, smoking status, alcohol consumption, or tumor subsite between the IS and surgical cohorts. Median follow-up was 9.4 years in the IS cohort and 7.1 years in the surgical cohort. INTERVENTIONS: Induction selection and CRT vs primary surgical extirpation with or without postoperative radiotherapy. MAIN OUTCOMES AND MEASURES: Overall and disease-specific survival and locoregional control. RESULTS: The Kaplan-Meier estimate for overall survival at 5 years was 32% in the IS cohort and 65% in the surgical cohort. The Kaplan-Meier estimate for disease-specific survival at 5 years was 46% in the IS cohort and 75% in the surgical cohort. The Kaplan-Meier estimate for locoregional control at 5 years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better overall and disease-specific survival and locoregional control outcomes (P = .03, P = .001, and P < .001, respectively) in the surgical cohort. CONCLUSIONS AND RELEVANCE: Primary surgical treatment showed significantly better survival and locoregional control compared with IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol vs primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.
Authors: Aaron W Pederson; Joseph K Salama; Mary Ellen Witt; Kerstin M Stenson; Elizabeth A Blair; Everett E Vokes; Daniel J Haraf Journal: Am J Clin Oncol Date: 2011-08 Impact factor: 2.339
Authors: David J Sher; Vijaya Thotakura; Tracy A Balboni; Charles M Norris; Robert I Haddad; Marshall R Posner; Jochen Lorch; Laura A Goguen; Donald J Annino; Roy B Tishler Journal: Int J Radiat Oncol Biol Phys Date: 2011-04-29 Impact factor: 7.038
Authors: Iris Gluck; Felix Y Feng; Teresa Lyden; Marc Haxer; Francis Worden; Douglas B Chepeha; Avraham Eisbruch Journal: Int J Radiat Oncol Biol Phys Date: 2009-09-23 Impact factor: 7.038
Authors: Francis P Worden; Bhavna Kumar; Julia S Lee; Gregory T Wolf; Kitrina G Cordell; Jeremy M G Taylor; Susan G Urba; Avraham Eisbruch; Theodoros N Teknos; Douglas B Chepeha; Mark E Prince; Christina I Tsien; Nisha J D'Silva; Kun Yang; David M Kurnit; Heidi L Mason; Tamara H Miller; Nancy E Wallace; Carol R Bradford; Thomas E Carey Journal: J Clin Oncol Date: 2008-05-12 Impact factor: 44.544
Authors: Douglas B Chepeha; Theodoros N Teknos; Josef Shargorodsky; Assuntina G Sacco; Teresa Lyden; Mark E Prince; Carol R Bradford; Gregory T Wolf Journal: Arch Otolaryngol Head Neck Surg Date: 2008-09
Authors: Kerstin M Stenson; Rangesh Kunnavakkam; Ezra E W Cohen; Louis D Portugal; Elizabeth Blair; Daniel J Haraf; Joseph Salama; Everett E Vokes Journal: Laryngoscope Date: 2010-01 Impact factor: 3.325
Authors: Ezra E W Cohen; Joshua Baru; Dezheng Huo; Daniel J Haraf; Maureen Crowley; Mary Ellyn Witt; Elizabeth A Blair; Ralph R Weichselbaum; Fred Rosen; Everett E Vokes; Kerstin Stenson Journal: Head Neck Date: 2009-08 Impact factor: 3.147
Authors: Remco de Bree; Alessandra Rinaldo; Eric M Genden; Carlos Suárez; Juan Pablo Rodrigo; Johannes J Fagan; Luiz P Kowalski; Alfio Ferlito; C René Leemans Journal: Eur Arch Otorhinolaryngol Date: 2007-08-08 Impact factor: 2.503
Authors: Carol M Lewis; Gaurav S Ajmani; Alexandra Kyrillos; Paul Chamberlain; Chi-Hsiung Wang; Cheryl C Nocon; Monica Peek; Mihir K Bhayani Journal: Head Neck Date: 2018-06-26 Impact factor: 3.147