Author: Ian S. Boon, Jean S. Lim, Moi H. Yap, Tracy P.T. Au Yong, Cheng S. Boon,
Abstract: Background Patients with locally advanced oral squamous cell cancer (LAOSCC) are treated with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT), following surgical ablation. This depends on pathological risk factors and aims to reduce local recurrence risk and improve survival. Delivery of these aggressive treatments is however challenging particularly following major surgery.
Aim Describe real world delivery of multimodality treatment in LAOSCC, in a UK population with high levels of disease incidence and low socioeconomic status, informing adaptations necessary to deliver gold standard therapy.
Method Patients with LAOSCC (T1-4 N1-3/T3-4 N0) treated between October 2014–October 2016 with a minimum 24 months follow-up were included. Patients were identified using Somerset Cancer Register and data collected through retrospective case note review. Approval was obtained from relevant NHS institution audit departments and data analysed using IBM SPSS Statistics 24.
Results Analysis included 129 patients with 82% having initial performance status (PS) of 0-1. The most frequent PS change was 1 point drop (46%). 20 out of 93 patients eligible (22%) underwent adjuvant CRT. 40% (37) began adjuvant CRT/RT within 42 days and 85% (79) within 56 days. Delay in initiating adjuvant therapy was associated with higher rates of complication and longer post-operative hospital stay. Concordance between imaging and pathological nodal staging was poor (cK 0.223).
Conclusion PS frequently declines after complex surgical procedures and long post-operative recovery periods leading to difficulties providing adjuvant treatments within the national guidance of 42 days. Frequent deviation from planned adjuvant therapies highlights the need for improved treatment strategies.
Keywords: Oral cancer; squamous cell carcinoma; chemoradiotherapy; maxillofacial surgery; adjuvant
