title: Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment.
abstract: BACKGROUND
  In our clinical practice, we have observed a high incidence of locoregional failure in squamous cell carcinoma (SCC) of the buccal mucosa. We analyze our treatment results of this cancer and compare these results with those in the literature. We intend to define the pattern and incidence of failure of buccal cancer and provide information for the design of a better multimodality treatment.
  
  
  METHODS
  During the period from 1983 through 2003, 121 previously untreated patients with M0 stage SCC of the buccal mucosa were treated with a curative intent at our hospital. Twenty-seven patients received surgery alone, 36 had radiotherapy alone, and 58 underwent surgery plus postoperative radiotherapy.
  
  
  RESULTS
  The 5-year locoregional control, overall survival, and cause-specific survival rates for all patients were 36.3%, 34.3%, and 36.9%, respectively. The locoregional recurrence rate was 57% for all patients, with 80% occurring in the primary site alone. Patients with T1-2N0 disease who received surgery alone still had a high local recurrence incidence of 41%. For patients with locally advanced disease, surgery plus postoperative radiotherapy achieved better overall survival and locoregional control rates than surgery alone or radiotherapy alone. T classification was the only prognostic factor affecting locoregional control and survival in the surgery alone group, whereas N classification and skin invasion predicted a poorer survival for the surgery plus postoperative radiotherapy group.
  
  
  CONCLUSIONS
  SCC of the buccal mucosa is an aggressive cancer with a high locoregional failure rate even in patients with T1-2N0 disease. Possible reasons include inadequate treatment and an intrinsically aggressive nature. Postoperative radiotherapy has resulted in a better locoregional control rate for patients with T3-4 or N+ disease and should also be considered for patients with T1-2N0 disease for whom adjuvant therapy after radical surgery currently is not recommended by most guidelines.
authors.affiliation: Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, 325 Section 2 Cheng-Kong Rd., Nei-Hu, Taipei, Taiwan, Republic of China.
authors.forename: Chun-Shu
authors.initials: CS
authors.lastname: Lin
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Cheng
authors.forename: Yaoh-Shiang
authors.initials: YS
authors.lastname: Lin
authors.forename: Wan-Fu
authors.initials: WF
authors.lastname: Su
authors.forename: Jing-Min
authors.initials: JM
authors.lastname: Hwang
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Chang
authors.forename: Hsing-Lung
authors.initials: HL
authors.lastname: Chao
authors.forename: Dai-Wei
authors.initials: DW
authors.lastname: Liu
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Weng-Yoon
authors.initials: WY
authors.lastname: Shum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002610:Cheek; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology*; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D015996:Survival Rate