Definitive radiotherapy for patients with nonresectable squamous cell carcinoma of the oral cavity

Abstract

Introduction

Surgery is standard of care for oral cavity cancer (OCC). We provide a single-institution experience using definitive radiotherapy for primary OCC when surgery is not possible due to patient comorbidities, patients preference or unresectable disease.

Material and Methods

We examined 49 patients with non-metastatic primary OCC treated definitively between 2000 and 2019. There were 5 patients treated with radiotherapy alone because of limited disease or no nodal involvement. The majority of patients (63.3%) were treated with chemotherapy while 26.5% were given single-agent cetuximab weekly.

Results

Median follow-up was 73 months. The median overall survival was 43 months. There were 65.3% locoregional failures in this cohort, 84.4% of which were local failures alone and 15.6% distant. The majority of patients who failed locally presented with American Joint Committee on Cancer (AJCC) Stage III-IV disease (59.2%). The 5-year Kaplan-Meier estimates for OS (III-IV vs. I-II) was 22.8% vs. 54.2 % (p=0.03). Patients who were treated with systemic therapy had a significant better 5-year overall survival compared to those with radiotherapy alone (43.9% vs. 23.1%). Mucositis was the most common ≥ Grade 3 acute toxicity in 19 patients (39%). Incidences of chronic toxicities were loss of taste, trismus, osteoradionecrosis and xerostomia.

Conclusion

Definitive treatment in patients with OCC resulted in an eloquent rate of locoregional control and good overall survival rates. Primary radiotherapy in combination with systemic therapy is currently the best available treatment option when surgery is not possible or rejected by the patient.