[Retrospective analysis of the prognostic significance of the manner of mandibular resection and adjuvant radiotherapy in para-mandibular carcinomas].
The prognostic effect of bone resection (continuous vs non-continuous) was analysed in a retrospective study of 100 patients who were treated for squamous cell carcinoma located close to the lower jaw, between 1983 and 1994. Tumour stage, type of bone resection, extent of lymphatic node resection, dose of radiotherapy and chemotherapy were documented. Prognosis was characterised by the statistical end points "death", "metastasis" and "relapse". Thirty-two stage pT2 carcinomas, half of which were treated by continuous and half by non-continuous resection of the lower jaw, showed the same occurrence of the statistical end points death, metastasis or relapse. There was a trend towards a significantly longer survival time and metastasis-free interval in the group of continuous resection. The hazard ratios, however, showed no effect depending on the type of resection. However, both tumour stage (pTNM) and dose of radiation independently influenced prognosis in multivariate analysis. Consequently, three groups were defined. Univariate analysis of 62 patients without radiotherapy vs 19 with low-dose radiotherapy (36 Gy) and 19 with high-dose (62 Gy) showed a positive effect on the rate and time of survival in the group treated with high-dose radiotherapy. This was confirmed by multivariate analysis showing significantly lower hazard ratios for death and metastasis in the high-dose radiotherapy group after adjusting to cofactors (e.g. tumour stage). The data of this study challenge the current concept of resection of the lower jaw. However, due to the low number of patients and the retrospective character of the study, it is not possible to give suggestions regarding established therapy concepts. The advances of a high-dose radiotherapy in this study should be the subject of further multicentre retrospective and prospective randomised trials.
Grötz
K A
KA
Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum, Johannes-Gutenberg-Universität Mainz. groetz@mkg.klinik.uni-mainz.de
Krummenauer
F
F
al-Nawas
B
B
Kuffner
H D
HD
Reichert
T E
TE
Wagner
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate