title: Postoperative concomitant chemoradiotherapy improved treatment outcomes of patients with oral cavity cancer with multiple-node metastases but no other major risk factors.
abstract: OBJECTIVE
  To investigate the results of postoperative radiotherapy (PORT) for the treatment of pathologic N2b/c squamous cell carcinoma of the oral cavity (OSCC).
  
  
  METHODS
  This study reviewed cancer registry data collected in our hospital from 1998 to 2009 with the following inclusion criteria: primary OSCC, treatment with radical surgery, and multiple nodal metastases. Patients who had extracapsular spreading of the lymph node metastases or positive resection margins or who refused to undergo PORT were excluded. The prescribed dose of PORT was 60-66 Gy. Concurrent chemotherapy was optional. Patient characteristics, treatment parameters and clinical outcome were recorded. The primary end point was overall survival, and the secondary endpoint was disease status.
  
  
  RESULTS
  There were 138 eligible cases, and the median follow-up period was 35 months. The 3-year overall survival rate was 56%. Univariate analysis revealed that pathologic T4 status (pT4), bone marrow invasion, and lymphatic invasion were significantly correlated with poor outcome (p<0.05). Multivariate analysis showed that pT4, lymphatic invasion, and the no concurrent chemotherapy were independent poor prognostic factors (p<0.05). Fifty-four patients had tumor recurrence. The 3-year recurrence-free survival rate was 59%. Skin invasion, pT4, and bone marrow invasion were correlated with poor prognosis in the univariate analysis (p<0.05). Only pT4 (p<0.01) and no concurrent chemotherapy (p = 0.03) were independently correlated with poor recurrence-free survival.
  
  
  CONCLUSIONS
  For OSCC patients with multiple-node metastases without extracapsular spreading or positive resection margins, PORT without concurrent chemotherapy correlated to inferior outcome. Multiple lymph node metastases might be considered an indication for concurrent chemotherapy.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; Graduate Institute of Clinical Medical Science, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kang-Hsing
authors.initials: KH
authors.lastname: Fan
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; Graduate Institute of Clinical Medical Science, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.affiliation: Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; Graduate Institute of Clinical Medical Science, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.affiliation: Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Department of Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.affiliation: Department of Hematology and Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan ; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011184:Postoperative Period; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome