title: Impact of positive frozen section microscopic tumor cut-through revised to negative on oral carcinoma control and survival rates.
abstract: BACKGROUND
  The objective of the study was to evaluate the prognostic and therapeutic implications of an initial positive frozen section margin that was revised until negative (microscopic tumor cut-through), and to analyze the influence of microscopic margin status on oral carcinoma control.
  
  
  METHODS
  The approach in our investigation was through a retrospective review of patients treated with primary surgery, with frozen section margin control in oral carcinoma. Inclusion criteria included availability of frozen and permanent section histology reports of resection margins and negative final resection margins.
  
  
  RESULTS
  Of 547 patients studied, 175 received adjuvant radiation. Local and regional control and disease-specific survival rates were 81.6%, 78.4%, and 76.3%, respectively. Tumor cut-through and pathologic nodal (pN) stage had an independently adverse effect on local control. Tumor cut-through adversely affected cancer control and survival, but this effect diminished significantly in the absence of regional disease.
  
  
  CONCLUSIONS
  Microscopic tumor cut-through revised to negative margins is a powerful prognosticator that is observed only when regional disease is also present. The value of adjuvant therapeutic regimens is questionable in patients with microscopic tumor cut-through, revised to negative margins, and with no regional disease.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre/Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada. drrajanspatel@gmail.com
authors.forename: Rajan S
authors.initials: RS
authors.lastname: Patel
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Jennifer
authors.initials: J
authors.lastname: Guillemaud
authors.forename: Guillem Andreu
authors.initials: GA
authors.lastname: Bruch
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Higgins
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Enepekides
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D055815:Young Adult