John R de Almeida1, Tra Truong2, Nazir Mohemmed Khan3, Jie Susie Su4, Jonathan Irish3, Ralph Gilbert3, David Goldstein3, Shao Hui Huang5, Brian O'Sullivan5, Ali Hosni5, Andrew Hope5, John Waldron5, Aaron R Hansen6, Anna Spreafico6, Lillian L Siu6, Bayardo Perez-Ordonez2, Wei Xu4, Ilan Weinreb2. 1. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Canada. Electronic address: john.dealmeida@uhn.ca. 2. Department of Pathology, University Health Network, Toronto, Canada. 3. Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Canada. 4. Department of Biostatistics, Princess Margaret Cancer Center, Toronto, Canada. 5. Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada. 6. Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.
Abstract
OBJECTIVES: To evaluate adjuvant chemoradiotherapy (CRT) for patients with oral cavity squamous cell carcinoma (OSCC) with minor or major extranodal extension (ENE). MATERIALS AND METHODS: Surgically resected OSCC with pathologically involved lymph node(s) (pN+) between 2006 and 2017. Sections of pN+ were re-reviewed and classified as no, minor (≤2 mm), or major (>2 mm) ENE. Patterns of failure and survival were compared between the groups and stratified by adjuvant treatment. Multivariable (MVA) analysis assessed the value of adjuvant treatment for minor and major ENE. RESULTS: Total of 384 patients, 62 had minor and 114 had major ENE. Adjuvant CRT was delivered in 32(15%), 21(34%), and 45(39%) of patients with no, minor and major ENE, respectively. Patients with minor ENE had similar 5-year loco-regional control (LRC) and distant control (DC) but lower disease-free survival (DFS) (38% vs. 51%, p = 0·02) compared to patients with no ENE, while patients with major ENE had marginally lower LRC (59% vs 74%, p = 0·07), lower DC (58% vs 82%,p = 0·005) and DFS (13% vs. 38%, p=·001) compared to those with minor. On MVA, adjuvant chemotherapy was associated with improved DFS for major ENE (adjusted HR = 0·49; 95% CI 0·29-0·85, p = 0·01) but not for minor ENE after adjusting for age, ECOG status, T-, N-category, margin status, and radiotherapy. CONCLUSIONS: Adjuvant chemoradiotherapy improves outcomes in patients with major ENE, but the benefit is unclear in patients with minor ENE. Future trials should focus on intensification of treatment for patients with major ENE and alternative adjuvant strategies for patients with minor ENE.
OBJECTIVES: To evaluate adjuvant chemoradiotherapy (CRT) for patients with oral cavity squamous cell carcinoma (OSCC) with minor or major extranodal extension (ENE). MATERIALS AND METHODS: Surgically resected OSCC with pathologically involved lymph node(s) (pN+) between 2006 and 2017. Sections of pN+ were re-reviewed and classified as no, minor (≤2 mm), or major (>2 mm) ENE. Patterns of failure and survival were compared between the groups and stratified by adjuvant treatment. Multivariable (MVA) analysis assessed the value of adjuvant treatment for minor and major ENE. RESULTS: Total of 384 patients, 62 had minor and 114 had major ENE. Adjuvant CRT was delivered in 32(15%), 21(34%), and 45(39%) of patients with no, minor and major ENE, respectively. Patients with minor ENE had similar 5-year loco-regional control (LRC) and distant control (DC) but lower disease-free survival (DFS) (38% vs. 51%, p = 0·02) compared to patients with no ENE, while patients with major ENE had marginally lower LRC (59% vs 74%, p = 0·07), lower DC (58% vs 82%,p = 0·005) and DFS (13% vs. 38%, p=·001) compared to those with minor. On MVA, adjuvant chemotherapy was associated with improved DFS for major ENE (adjusted HR = 0·49; 95% CI 0·29-0·85, p = 0·01) but not for minor ENE after adjusting for age, ECOG status, T-, N-category, margin status, and radiotherapy. CONCLUSIONS: Adjuvant chemoradiotherapy improves outcomes in patients with major ENE, but the benefit is unclear in patients with minor ENE. Future trials should focus on intensification of treatment for patients with major ENE and alternative adjuvant strategies for patients with minor ENE.
Authors: Eder da Silva Dolens; Mauricio Rocha Dourado; Alhadi Almangush; Tuula A Salo; Clarissa Araujo Gurgel Rocha; Sabrina Daniela da Silva; Peter A Brennan; Ricardo D Coletta Journal: Front Oncol Date: 2021-11-10 Impact factor: 6.244
Authors: Alessia Di Rito; Francesco Fiorica; Roberta Carbonara; Francesca Di Pressa; Federica Bertolini; Francesco Mannavola; Frank Lohr; Angela Sardaro; Elisa D'Angelo Journal: Cancers (Basel) Date: 2022-07-29 Impact factor: 6.575
Authors: Flora Yan; Hong Li; John R de Almeida; John M Kaczmar; Patrik Pipkorn; Joseph Zenga; Mary S Richardson; David M Neskey; Anand K Sharma; Terry A Day; Evan M Graboyes Journal: Otolaryngol Head Neck Surg Date: 2021-02-23 Impact factor: 5.591