Katsoulakis E, et al. - Authors evaluated the outcomes of recurrent oral cavity squamous cell carcinoma (OCSCC) treated with salvage surgery and radiation vs outcomes for patients treated with adjuvant postoperative radiotherapy (RT) upfront. Compared to locally advanced patients who got upfront adjuvant RT, early-stage OCSCC patients who were observed and had recurrence needing salvage therapy (surgery and RT) had worse oncologic outcomes.

Methods

• Researchers identified 425 patients having OCSCC treated with postoperative RT.
• The main outcome measures were the 5-year rates of local failure, locoregional failure (LRF), survival, and distant metastasis (DM).
• A landmark analysis was performed by the experts and they examined the same outcomes in the adjuvant vs salvage cohorts, using Cox proportional hazards and Fine-Gray competing risk method.

Results

• The adjuvant cohort had higher tumor (T) (P < 0.0001) and nodal (N) (P < 0.0001) stage vs the salvage cohort's stage at initial presentation.
• Salvage RT experienced poorer overall survival (OS) vs upfront adjuvant RT (hazard ratio [HR] 1.84; 95% confidence interval [CI], 1.26–2.70; P=0.002), on multivariate analysis.
• Furthermore, on multivariate analysis, increasing risk of LRF (HR 1.56; 95% CI, 1.18–2.06; P=0.002) and DM (HR 1.53; 95% CI, 1.08–2.17; P=0.02) was experienced by patients who had salvage surgery followed by RT.
• Compared to adjuvant RT (HR 1.48; 95% CI, 1.002–2.19; P=0.049), salvage RT treatment selection for early-stage OCSCC continued to experience significantly poorer OS.