Adjuvant management of locally advanced oral squamous cell carcinoma – real world challenges and opportunities
Autor: | A. Hobkirk, Andrew Schache, A. Haridass, D. Broderick, Joseph J. Sacco, H. Cashman, Panayiotis A. Kyzas, R.C. Brooker, Takaaki Sato, H. Wong |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment Concordance Population 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Adjuvant therapy Humans 030223 otorhinolaryngology education Pathological Neoplasm Staging Retrospective Studies education.field_of_study Performance status business.industry Squamous Cell Carcinoma of Head and Neck Cancer Chemoradiotherapy Chemoradiotherapy Adjuvant medicine.disease Treatment Outcome Otorhinolaryngology Head and Neck Neoplasms 030220 oncology & carcinogenesis Carcinoma Squamous Cell Surgery Mouth Neoplasms Radiotherapy Adjuvant Oral Surgery Neoplasm Recurrence Local business Adjuvant |
Zdroj: | British Journal of Oral and Maxillofacial Surgery |
Popis: | Patients with locally advanced oral squamous cell cancer (LAOSCC) are treated with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) following surgical ablation. This depends on the pathological risk factors and aims to reduce the risk of local recurrence and improve survival. Delivery of these aggressive treatments is, however, challenging particularly following major surgery. To inform the adaptations necessary to deliver gold-standard therapy, we aimed to describe real-world delivery of multimodality treatment in LAOSCC, in a UK population with high levels of disease incidence and low socioeconomic status. Patients with LAOSCC (T1-4 N1-3/T3-4 N0) who were treated between October 2014 and October 2016 and had a minimum follow up of 24 months were included. They were identified using the Somerset Cancer Register and data were collected through retrospective case note review. Approval was obtained from the audit departments at the relevant NHS institutions, and data were analysed using IBM SPSS Statistics for Windows version 24 (IBM Corp). The analysis included 129 patients with 82% having an initial performance status (PS) of 0-1. The most frequent change in PS was a one point drop (46%). Twenty of the 93 eligible patients (22%) underwent adjuvant CRT. A total of 37 (40%) began adjuvant CRT/RT within 42 days, and 79 (85%) within 56 days. A delay in initiating adjuvant therapy was associated with higher rates of complications and a longer postoperative hospital stay. Concordance between imaging and pathological nodal staging was poor (cK 0.223). PS frequently declines after complex surgical procedures and long postoperative recovery periods, leading to difficulties providing adjuvant treatments within the national guidance of 42 days. Frequent deviation from planned adjuvant therapies highlights the need for improved treatment strategies. |
Databáze: | OpenAIRE |
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