Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Laryngoscope. 2017 Jun;127(6):1334-1338. doi: 10.1002/lary.26443. Epub 2017 Feb 1.

Abstract

Objective: To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity.

Study design: Cross-sectional population analysis.

Methods: Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT.

Results: A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC.

Conclusion: Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence.

Level of evidence: 2C. Laryngoscope, 127:1334-1338, 2017.

Keywords: SEER; T stage; Verrucous carcinoma; cancer; head and neck cancer; oral cavity; radiation therapy; survival.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / radiotherapy
  • Carcinoma, Squamous Cell / surgery
  • Carcinoma, Verrucous / mortality*
  • Carcinoma, Verrucous / radiotherapy
  • Carcinoma, Verrucous / surgery
  • Cross-Sectional Studies
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / radiotherapy
  • Head and Neck Neoplasms / surgery
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mouth
  • Mouth Neoplasms / mortality*
  • Mouth Neoplasms / radiotherapy
  • Mouth Neoplasms / surgery
  • Neoplasm Recurrence, Local / mortality
  • Radiotherapy, Adjuvant / methods
  • Radiotherapy, Adjuvant / mortality*
  • SEER Program
  • Squamous Cell Carcinoma of Head and Neck
  • Treatment Outcome