title: Cancer of retromolar trigone: long-term radiation therapy outcome.
abstract: BACKGROUND
  Cancer of the retromolar trigone is an uncommon head and neck cancer. In this retrospective study, we identified the prognostic factors and evaluated the therapeutic outcomes of patients treated with preoperative radiation therapy (RT), postoperative RT, and RT alone.
  
  
  METHODS
  Between 1971 and 1994, 65 patients with histologically proven epidermoid carcinoma of the retromolar trigone were treated at the Mallinckrodt Institute of Radiology; 10 patients received preoperative RT (30-55.2 Gy), 39 received postoperative RT (46-66.6 Gy), and 15 were treated with RT alone (63-74 Gy). Surgery included 44 composite resections and 7 wide excisions. The minimum follow-up was 5 years.
  
  
  RESULTS
  The 5-year disease-free survival rates were 90% with preoperative RT, 63% with postoperative RT, and 31% with RT alone. The 5-year disease-free survival rates were 76% for patients with T1 disease, 50% for T2, 72% for T3, and 54% for T4. The 5-year disease-free survival rates were 69% for patients with NO disease, 56% for N1, and 26% for N2. The locoregional recurrence rates were 10% (1 of 10) for preoperative RT, 23% (9 of 39) for postoperative RT, and 44% (7 of 16) for RT alone. On multivariate analysis, the significant factors for disease-free survival were treatment modality (p =.002) and N stage (p =.012); for locoregional control it was treatment modality (p =.046); and for distant metastasis it was N stage (p =.002). The incidence of bone necrosis, soft tissue necrosis, and severe trismus was 12% with postoperative RT, 11% with RT alone, and none with preoperative RT.
  
  
  CONCLUSIONS
  Combination surgery with postoperative or preoperative RT offers better locoregional control and disease-free survival than RT alone for epidermoid carcinoma of the retromolar trigone. Lymph node status significantly influences the disease-free survival and distant metastasis rates.
authors.affiliation: Radiation Oncology Center, Mallinckrodt Institute of Radiology Washington University Medical Center, 4939 Children's Place, Suite 5500, St. Louis, MO 63110, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Huang
authors.forename: K S
authors.initials: KS
authors.lastname: Chao
authors.forename: J
authors.initials: J
authors.lastname: Tsai
authors.forename: J R
authors.initials: JR
authors.lastname: Simpson
authors.forename: B
authors.initials: B
authors.lastname: Haughey
authors.forename: G J
authors.initials: GJ
authors.lastname: Spector
authors.forename: D G
authors.initials: DG
authors.lastname: Sessions
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome