title: Resection of early oral squamous cell carcinoma with positive or close margins: relevance of adjuvant treatment in relation to local recurrence: margins of 3 mm as safe as 5 mm.
abstract: OBJECTIVE
  The treatment strategy of early stage oral squamous cell carcinoma's (OSCC) resected with close or involved margins is a returning point of discussion. In this study we reviewed the consequences of re-resection (RR), postoperative radiotherapy (PORT) or watchful waiting (WW).
  
  
  METHODS
  Two-hundred patients with a primary resected Stage 1-2 OSCC of the tongue, floor of the mouth and cheek were included and retrospectively analysed. Local recurrence ratio was related to margin status, unfavourable histological parameters (spidery infiltrative, peri-neural and vascular-invasive growth) and postoperative treatment modality. 3-year overall survival (OS) and disease-specific survival (DSS) was calculated in relation to margin status.
  
  
  RESULTS
  Twenty-two of 200 (11%) patients had pathological positive margins (PM), 126 (63%) close margins (CM), and 52 (26%) free margins (FM). OS and DSS were not significantly different between these groups. Nine of 200 (4.5%) patients developed local recurrent disease. Two (9.1%) had a PM, five (4.0%) a CM and two (3.8%) a FM. Of the nine recurrences, five patients had undergone PORT, one a RR, and three follow-up. Watchful waiting for CM ⩾3 mm with ⩽2 unfavourable histological parameters showed, besides margin status no significant differences with the FM group.
  
  
  CONCLUSIONS
  With this treatment strategy, the local recurrence rate was 4.5%. No evidence was found for local adjuvant treatment in case of close margins ⩾3 mm with ⩽2 unfavourable histological parameters. Current data do not support the use of one treatment modality above any other.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. Electronic address: eric.dik@mumc.nl.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Dik
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Willems
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
authors.forename: Norbertus A
authors.initials: NA
authors.lastname: Ipenburg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
authors.forename: Sven O
authors.initials: SO
authors.lastname: Adriaansens
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
authors.forename: Antoine J W P
authors.initials: AJ
authors.lastname: Rosenberg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
authors.forename: Robert J J
authors.initials: RJ
authors.lastname: van Es
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016019:Survival Analysis; D057832:Watchful Waiting
keywords: Head neck cancer; Local recurrence; Oral squamous cell carcinoma; Pathological margin status; Post-operative radiotherapy; Re-resection