Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence.
BACKGROUND
Most treatment failure of buccal mucosal cancer post surgery is locoregional recurrence. We tried to figure out how close the surgical margin being unsafe and needed further adjuvant treatment.


METHODS
Between August 2000 and June 2008, a total of 110 patients with buccal mucosa carcinoma (25 with stage I, 31 with stage II, 11 with stage III, and 43 with Stage IV classified according to the American Joint Committee on Cancer 6th edition) were treated with surgery alone (n = 32), surgery plus postoperative radiotherapy (n = 38) or surgery plus adjuvant concurrent chemoradiotherapy (n = 40).


METHODS
The primary endpoint was locoregional disease control.


RESULTS
The median follow-up time at analysis was 25 months (range, 4-104 months). The 3-year locoregional control rates were significantly different when a 3-mm surgical margin (≤3 versus >3 mm, 71% versus 95%, p = 0.04) but not a 5-mm margin (75% versus 92%, p = 0.22) was used as the cut-off level. We also found a quantitative correlation between surgical margin and locoregional failure (hazard ratio, 2.16; 95% confidence interval, 1.14 - 4.11; p = 0.019). Multivariate analysis identified pN classification and surgical margin as independent factors affecting disease-free survival and locoregional control.


CONCLUSIONS
Narrow surgical margin ≤3 mm, but not 5 mm, is associated with high risk for locoregional recurrence of buccal mucosa carcinoma. More aggressive treatment after surgery is suggested.
Chiou
Wen-Yen
WY
Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
Lin
Hon-Yi
HY
Hsu
Feng-Chun
FC
Lee
Moon-Sing
MS
Ho
Hsu-Chueh
HC
Su
Yu-Chieh
YC
Lee
Ching-Chih
CC
Hsieh
Chen-Hsi
CH
Wang
Yao-Ching
YC
Hung
Shih-Kai
SK
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D009061:Mouth Mucosa / Q000473:pathology*; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures; D011379:Prognosis; D011878:Radiotherapy; D016896:Treatment Outcome
D000970:Antineoplastic Agents