Resection of early oral squamous cell carcinoma with positive or close margins: Relevance of adjuvant treatment in relation to local recurrence Margins of 3 mm as safe as 5 mm

• Published in: Oral oncology Vol. 50; no. 6; pp. 611 - 615
• Main Authors: DIK, Eric A, WILLEMS, Stefan M, IPENBURG, Norbertus A, ADRIAANSENS, Sven O, ROSENBERG, Antoine J. W. P, VAN ES, Robert J. J
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 01.06.2014
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Female; Humans; Male; Medical sciences; Middle Aged; Mouth Neoplasms - pathology; Mouth Neoplasms - radiotherapy; Mouth Neoplasms - surgery; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local; Otorhinolaryngology. Stomatology; Retrospective Studies; Survival Analysis; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Watchful Waiting; Postoperative; Relapse; Stomatology; Local recurrence; Adjuvant treatment; Surgical resection; Pathological margin status; ENT; Oral squamous cell carcinoma; Malignant tumor; Radiotherapy; Re-resection; Cancerology; Surgery; Head and neck; Early; Head neck cancer; Oral cavity disease; Post-operative radiotherapy; Cancer
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2014.02.014

The treatment strategy of early stage oral squamous cell carcinoma's (OSCC) resected with close or involved margins is a returning point of discussion. In this study we reviewed the consequences of re-resection (RR), postoperative radiotherapy (PORT) or watchful waiting (WW). Two-hundred patients with a primary resected Stage 1-2 OSCC of the tongue, floor of the mouth and cheek were included and retrospectively analysed. Local recurrence ratio was related to margin status, unfavourable histological parameters (spidery infiltrative, peri-neural and vascular-invasive growth) and postoperative treatment modality. 3-year overall survival (OS) and disease-specific survival (DSS) was calculated in relation to margin status. Twenty-two of 200 (11%) patients had pathological positive margins (PM), 126 (63%) close margins (CM), and 52 (26%) free margins (FM). OS and DSS were not significantly different between these groups. Nine of 200 (4.5%) patients developed local recurrent disease. Two (9.1%) had a PM, five (4.0%) a CM and two (3.8%) a FM. Of the nine recurrences, five patients had undergone PORT, one a RR, and three follow-up. Watchful waiting for CM ⩾3 mm with ⩽2 unfavourable histological parameters showed, besides margin status no significant differences with the FM group. With this treatment strategy, the local recurrence rate was 4.5%. No evidence was found for local adjuvant treatment in case of close margins ⩾3 mm with ⩽2 unfavourable histological parameters. Current data do not support the use of one treatment modality above any other.