Ardalan Ebrahimi1,2,3,4, Ziv Gil5,6, Moran Amit5,6, Tzu-Chen Yen7, Chun-Ta Liao8, Pankaj Chaturvedi9, Jai Prakash Agarwal10, Luiz P Kowalski11, Hugo F Köhler11, Matthias Kreppel12, Claudio R Cernea13, Jason Brandao13, Gideon Bachar14, Andrea Bolzoni Villaret15, Dan M Fliss16, Eran Fridman16, Kevin Thomas Robbins17, Jatin P Shah18, Snehal G Patel18, Jonathan R Clark1,19,20. 1. Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 2. Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia. 3. Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia. 4. Medical School, College of Health and Medicine, Australian National University, Canberra, Australia. 5. Laboratory for Applied Cancer Research, Technion-Israel Institute of Technology, Haifa, Israel. 6. Department of Otolaryngology Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel institute of technology, Haifa, Israel. 7. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 8. Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 9. Department of Head & Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India. 10. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India. 11. Department of Head & Neck Surgery, Hospital A.C. Camargo, São Paulo, Brazil. 12. Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany. 13. Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. 14. Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Israel. 15. Department of ENT, University of Brescia, Brescia, Italy. 16. Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. 17. Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois. 18. Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York City, New York. 19. Medical School, University of New South Wales, Sydney, New South Wales, Australia. 20. Medical School, Sydney University, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC). METHODS: Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease-specific survival (DSS) in a multi-institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990-2011. RESULTS: In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5-year disease-specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5-10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%. CONCLUSION: The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial.
BACKGROUND: We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC). METHODS: Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease-specific survival (DSS) in a multi-institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990-2011. RESULTS: In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5-year disease-specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5-10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%. CONCLUSION: The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial.
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