title: Mortality and causes of death after multimodality treatment for advanced oral and oropharyngeal cancer.
abstract: OBJECTIVE
  To analyze mortality and causes of death in patients who received preoperative radiochemotherapy and underwent radical surgery for advanced oral or oropharyngeal cancer.
  
  
  METHODS
  A total of 222 patients who underwent multimodality treatment from 1990 to 2000 were included in the study. The inclusion criterion was International Union Against Cancer (UICC) disease stage II to IV (T2, 33.3%; T3, 12.6%; T4, 54.1%). Patients received preoperative radiotherapy 50 Gy and concomitant chemotherapy with mitomycin and 5-fluorouracil. Radical local-regional en bloc resection was performed in all patients. Survival status and causes of death were ascertained from the National Health Registry. Death certificates and autopsy reports were consulted when hospital files failed to provide reliable data.
  
  
  RESULTS
  After a median surveillance period of 72.3 months (range, 24 to 152 months), 59% of patients were alive, 21% had died of recurrence, 5% had died perioperatively, and 15% had died from other causes. Of these, a second cancer in the head and neck region or the lower respiratory tract or the upper digestive tract was found in 7.3%. Although 93% of deaths related to recurrent disease occurred within the first 36 months after surgery, the remaining causes of death did not reveal a specific temporal pattern.
  
  
  CONCLUSIONS
  Favorable survival data were registered for patients with advanced squamous cell carcinoma of the oral cavity who underwent combined treatment protocols. These patients frequently die of comorbidities. Because recurrent disease is a less common cause of mortality than are other causes, the latter should receive attention during surveillance.
authors.affiliation: University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Vienna, University Hospital Vienna, Vienna, Austria. arno.wutzl@meduniwien.ac.at
authors.forename: Arno
authors.initials: A
authors.lastname: Wutzl
authors.forename: Oliver
authors.initials: O
authors.lastname: Ploder
authors.forename: Christian
authors.initials: C
authors.lastname: Kermer
authors.forename: Werner
authors.initials: W
authors.lastname: Millesi
authors.forename: Rolf
authors.initials: R
authors.lastname: Ewers
authors.forename: Clemens
authors.initials: C
authors.lastname: Klug
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000401:mortality; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors