The prognostic impact of extent of bone invasion and extent of bone resection in oral carcinoma.

OBJECTIVE: The prognostic impact of mandibular invasion by oral squamous cell carcinoma (SCC) is controversial. The objective of this study was to assess the effect that extent of bone invasion has on recurrence and survival in patients treated with marginal and segmental mandible resection. STUDY DESIGN: A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively into a dedicated head and neck database. METHODS: Local control and disease-specific survival were retrospectively reviewed in 111 patients (median follow-up, 44 months) with oral SCC undergoing marginal or segmental mandibulectomy. RESULTS: Bone invasion was present in 46% of marginal and 94% of segmental resections. Five-year local control was similar following marginal (83%) and segmental mandibulectomy (86%). There was no correlation with presence or extent of bone invasion. Survival at 5 years was 71% and this correlated with bone invasion and involved margins (P < .05), but not with extent of mandible invasion or resection. CONCLUSIONS: Marginal mandibulectomy does not adversely alter outcome in selected patients with bone invasion provided margins are not compromised.

The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx.

OBJECTIVES/HYPOTHESIS: To determine whether definitive radiotherapy prior to surgery increases the rate of pharyngocutaneous fistula (PCF) following laryngectomy or hypopharyngectomy and to determine if differences in duration of time between definitive radiotherapy and surgery alters PCF rate. STUDY DESIGN: A retrospective review of 152 patients treated surgically for primary laryngeal or hypopharyngeal squamous cell carcinoma. METHODS: Following previous definitive radiotherapy treatment 38 patients underwent salvage surgery and 114 patients underwent primary surgery with curative intent. The PCF rate was assessed in both groups. RESULTS: The rate of PCF was found to be significantly higher in the salvage surgery group than those undergoing primary surgery (34.2% vs. 15.7%) (P < .05). Fistula rate was also higher in the subgroup that received concurrent chemoradiation to radiotherapy alone (P = .002). The patients who developed PCF in the salvage surgery group had significantly lower median time to surgery (5.8 months) than the nonfistula group (9.8 months) (P = .032). PCF rate was 75% within 4 months of radiotherapy to salvage surgery compared to 25% after 4 months (P = .034). Within 12 months of radiotherapy this percentage was 48% compared to 0% after 12 months (P = .014). The median radiotherapy dose was significantly higher in those whose surgery was complicated by PCF (70 Gy) compared to patients who did not develop a fistula (64 Gy) (P = .001). CONCLUSIONS: Patients undergoing salvage surgery within 12 months, and in particular within 4 months, who have received high dose radiotherapy (>64 Gy) or concurrent chemoradiation are at high risk of developing PCF.