title: Preoperative vs. postoperative radiochemotherapy in patients with N2 squamous cell carcinoma of the oral cavity.
abstract: BACKGROUND
  The aim of our study was to evaluate retrospectively whether neoadjuvant or adjuvant radiochemotherapy yields better survival for patients with N2-oral squamous cell carcinoma and to identify subgroups, which may benefit from one of the therapeutic settings. No studies have been carried out to investigate whether radiochemotherapy should be applied before or after surgery.
  
  
  METHODS
  In total, 151 patients with oral squamous cell carcinoma with N2-nodal-status were reviewed. Eighty five patients received neoadjuvant radiochemotherapy, 66 patients were treated with surgery and adjuvant radiochemotherapy. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis.
  
  
  RESULTS
  Patients treated with neoadjuvant radiochemotherapy had a significantly improved 5-year survival in comparison to patients, who received adjuvant radiochemotherapy (46.3% vs. 27.4%, p=0.035). A subgroup analysis by T-stage revealed that neoadjuvant and adjuvant radiochemotherapy yielded similar 5-year survival rates for patients with T2N2-tumors (42.3% vs. 41.2%, p=0.871), whereas patients with T4bN2-tumors significantly benefitted from neoadjuvant treatment (37.3% vs. 9.7%, p=0.019).
  
  
  CONCLUSIONS
  Neoadjuvant radiochemotherapy is an effective treatment for patients with nodal status N2-oral squamous cell carcinoma, however prospective randomized trials are needed to confirm, which patients should be treated with neoadjuvant or adjuvant radiochemotherapy.
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany. Electronic address: mattheskreppel@yahoo.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kreppel
authors.affiliation: Department of Radiation Oncology, University of Münster, Germany.
authors.forename: Hans-Theodor
authors.initials: HT
authors.lastname: Eich
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brüggenolte
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Dreiseidler
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rothamel
authors.affiliation: Department of Pathology, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Drebber
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Würzburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kübler
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Zöller
authors.affiliation: Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany; Center of Integrated Oncology (CIO), Cologne-Bonn, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scheer
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000628:therapy*; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome