title: Efficacy of induction selection chemotherapy vs primary surgery for patients with advanced oral cavity carcinoma.
abstract: OBJECTIVE
  The University of Michigan has investigated the use of induction selection (IS) with chemoradiotherapy (CRT) for patients who respond to CRT and found this approach effective in the management of advanced laryngeal cancer. The IS approach was extended to oral cavity squamous cell carcinoma (OCSCC) to help understand whether organ preservation or survival benefit resulted.
  
  
  OBJECTIVE
  To evaluate the efficacy of an IS protocol vs primary surgical extirpation and selective postoperative radiotherapy for advanced OCSCC.
  
  
  METHODS
  Retrospective matched cohort study at a tertiary care hospital.
  
  
  METHODS
  Nineteen patients with resectable stages III and IV OCSCC were enrolled into a phase 2 IS trial. Patients with a response of at least 50% underwent concurrent CRT; those with a response of less than 50% underwent surgical treatment and radiotherapy. A comparison cohort of patients treated with primary surgical extirpation during a similar time period was frequency matched for inclusion criteria and patient characteristics to those patients included from the phase 2 IS trial. No difference was noted in age, sex, pretreatment American Joint Committee on Cancer stage, T and N classifications, smoking status, alcohol consumption, or tumor subsite between the IS and surgical cohorts. Median follow-up was 9.4 years in the IS cohort and 7.1 years in the surgical cohort.
  
  
  METHODS
  Induction selection and CRT vs primary surgical extirpation with or without postoperative radiotherapy.
  
  
  METHODS
  Overall and disease-specific survival and locoregional control.
  
  
  RESULTS
  The Kaplan-Meier estimate for overall survival at 5 years was 32% in the IS cohort and 65% in the surgical cohort. The Kaplan-Meier estimate for disease-specific survival at 5 years was 46% in the IS cohort and 75% in the surgical cohort. The Kaplan-Meier estimate for locoregional control at 5 years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better overall and disease-specific survival and locoregional control outcomes (P = .03, P = .001, and P < .001, respectively) in the surgical cohort.
  
  
  CONCLUSIONS
  Primary surgical treatment showed significantly better survival and locoregional control compared with IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol vs primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Chinn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.affiliation: Comprehensive Cancer Center Biostatistics Unit, University of Michigan, Ann Arbor.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Bellile
authors.affiliation: Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Rozek
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
authors.forename: Tasha
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor4now with Department of Otolaryngology-Head and Neck Surgery, Ohio State University Medical Center, Columbus.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Comprehensive Cancer Center, University of Michigan, Ann Arbor6Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Urba
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Carey
authors.affiliation: Comprehensive Cancer Center, University of Michigan, Ann Arbor7Department of Radiation Oncology, University of Michigan, Ann Arbor.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.affiliation: Comprehensive Cancer Center, University of Michigan, Ann Arbor6Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor5Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009062:Mouth Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures / Q000379:methods*; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome