Surgical outcome of T4a and resected T4b oral cavity cancer

Authors

  • Chun-Ta Liao MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    2. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
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  • Joseph Tung-Chieh Chang MD, MHA,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Department of Radiation Oncology, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • Hung-Ming Wang MD,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Division of Hematology/Oncology, Department of Internal Medicine, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • Shu-Hang Ng MD,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Department of Diagnostic Radiology, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • Chuen Hsueh MD,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Department of Pathology, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • Li-Yu Lee MD,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Department of Pathology, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • Chih Hung Lin MD,

    1. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
    2. Department of Plastic and Reconstructive Surgery, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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  • I-How Chen MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    2. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
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  • Chung-Jan Kang MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    2. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
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  • Shiang-Fu Huang MD,

    1. Department of Otorhinolaryngology, Head and Neck Surgery, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    2. Taipei Chang Gung Head and Neck Oncology Group, Chang Gung, Taiwan
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  • Ming-fong Tsai MD,

    1. Department of Nuclear Medicine, Jiayi Chang Gung Memorial Hospital, Chang Gung, Taiwan
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  • Tzu-Chen Yen MD, PhD

    Corresponding author
    1. Department of Nuclear Medicine, Jiayi Chang Gung Memorial Hospital, Chang Gung, Taiwan
    2. Department of Nuclear Medicine, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    3. Department of Molecular Imaging Center, Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
    • Department of Nuclear Medicine, Chang Gung Memorial Hospital at Taipei, 199, Tung Hwa North Road, Taipei 105, Taiwan, R.O.C.
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    • Fax: (011) 886-3211 0052


Abstract

BACKGROUND.

The American Joint Committee on Cancer (AJCC) 2002 staging system (AJCC 2002) suggested that squamous cell carcinoma of the oral cavity (OSCC) with T4b is unresectable. The current retrospective results show that selected T4b patients were resectable with favorable outcomes.

METHODS.

From January 1996 to December 2000, 103 consecutive untreated T4 OSCC patients (reclassified by AJCC 2002) without carotid artery encasement and skull base extension were eligible for radical treatment. All received head-and-neck magnetic resonance imaging (MRI) and/or computed tomography (CT) scans before operation. The surgical principles were safety margins of ≥1 cm for primary tumors, modified/radical neck dissections for clinical lymph node-positive disease, and supraomohyoid neck dissection for lymph node-negative disease. In all, 95.1% of patients (98 of 103 patients) underwent free-flap reconstructions. Adjuvant radiotherapy or concomitant chemoradiotherapy was administed to those with pathological T4 (AJCC 1997), cervical lymph node metastasis, or close margins (≤4 mm). Survivals were calculated according to the method of Kaplan and Meier.

RESULTS.

In all, 58 patients were classified as having T4a disease and 45 were classified as having T4b disease. No statistical difference was observed in the 5-year local control, neck control, disease-free survival, and overall survival rates between the T4a and T4b groups. In multivariate analyses, pathologic lymph node status (pN0-1 vs. pN2) was found to be the sole independent predictor for T4b for local control (P = .012), disease-free survival (P = .005), and overall survival (P = .008).

CONCLUSIONS.

Selected T4b OSCC patients were found to be resectable with outcomes that were comparable to those of T4a OSCC patients and may benefit from radical surgery, free-flap reconstruction, and adjuvant therapy. A pathologic lymph node status of ≥2 was found to be the sole independent predictor for T4b disease in local control and survival. Cancer 2006. © 2006 American Cancer Society.

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