Impact of positive frozen section microscopic tumor cut-through revised to negative on oral carcinoma control and survival rates

• Published in: Head & neck Vol. 32; no. 11; pp. 1444 - 1451
• Main Authors: Patel, Rajan S., Goldstein, David P., Guillemaud, Jennifer, Bruch, Guillem Andreu, Brown, Dale, Gilbert, Ralph W., Gullane, Patrick J., Higgins, Kevin M., Irish, Jonathan, Enepekides, Danny J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.11.2010; Wiley
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Disease-Free Survival; Female; frozen section; Frozen Sections; Humans; local control; Lymph Nodes - pathology; Male; Medical sciences; Middle Aged; Mouth Neoplasms - mortality; Mouth Neoplasms - pathology; Mouth Neoplasms - therapy; oral squamous cell carcinoma; Otorhinolaryngology. Stomatology; Prognosis; Radiotherapy, Adjuvant; survival; Survival Rate; tumor margin; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult; tumor margin; Prognosis; frozen section; Stomatology; local control; Oral cavity carcinoma; Oral cavity disease; ENT; Malignant tumor; Oral squamous cell carcinoma; Survival; Cancer
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.21334

Background The objective of the study was to evaluate the prognostic and therapeutic implications of an initial positive frozen section margin that was revised until negative (microscopic tumor cut‐through), and to analyze the influence of microscopic margin status on oral carcinoma control. Methods The approach in our investigation was through a retrospective review of patients treated with primary surgery, with frozen section margin control in oral carcinoma. Inclusion criteria included availability of frozen and permanent section histology reports of resection margins and negative final resection margins. Results Of 547 patients studied, 175 received adjuvant radiation. Local and regional control and disease‐specific survival rates were 81.6%, 78.4%, and 76.3%, respectively. Tumor cut‐through and pathologic nodal (pN) stage had an independently adverse effect on local control. Tumor cut‐through adversely affected cancer control and survival, but this effect diminished significantly in the absence of regional disease. Conclusions Microscopic tumor cut‐through revised to negative margins is a powerful prognosticator that is observed only when regional disease is also present. The value of adjuvant therapeutic regimens is questionable in patients with microscopic tumor cut‐through, revised to negative margins, and with no regional disease. © 2010 Wiley Periodicals, Inc. Head Neck, 2010