Consistent multimodality approach to oral cavity and high-risk oropharyngeal cancer in veterans

Am J Otolaryngol. 2021 Nov-Dec;42(6):103166. doi: 10.1016/j.amjoto.2021.103166. Epub 2021 Jul 27.


Purpose: High-risk oropharyngeal squamous cell carcinoma (OPSCC) associated with tobacco exposure remains difficult to treat due to high rates of locoregional recurrence similar to oral cavity squamous cell carcinoma (OCSCC). Current NCCN guidelines allow for surgical management of this disease, but oncologic and functional data in the modern era remain scarce. We sought to compare and contrast oncologic and functional considerations for surgical management of OPSCC and OCSCC in a cohort of Veterans.

Materials and methods: We conducted a retrospective review of patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2017 and 2020, treated using a homogenous, multi-modality algorithm.

Results: OPSCC tumors presented with a higher rate of perineural invasion (p < 0.05) and extranodal extension (p = 0.02) compared to OCSCC tumors. Compliance with NCCN guidelines for adjuvant treatment were lower for OPSCC patients primarily due to a higher rate of previous irradiation; re-irradiation could be delivered in 75% of patients when recommended by NCCN guidelines. Total glossectomy was accompanied by concomitant total laryngectomy in 100% of OPSCC patients and 0% of OCSCC.

Conclusion: Surgical resection and free flap reconstruction of high-risk OPSCC generates oncologic outcomes comparable to OCSCC with comparable complication rates but a lower overall functional status. Reconstruction focused on rapid healing allows for high-rates of re-irradiation and minimal treatment delays.

Level of evidence: level 4.

Keywords: Free flap reconstruction; Oral cavity; Oropharynx; Re-irradiation; Total glossectomy; Veteran.

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Female
  • Free Tissue Flaps
  • Glossectomy
  • Humans
  • Laryngectomy
  • Male
  • Middle Aged
  • Mouth / surgery*
  • Neoplasm Invasiveness
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / radiotherapy
  • Oropharyngeal Neoplasms / surgery*
  • Otorhinolaryngologic Surgical Procedures / methods*
  • Practice Guidelines as Topic
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Risk
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / radiotherapy
  • Squamous Cell Carcinoma of Head and Neck / surgery*
  • Treatment Outcome
  • Veterans Health*
  • Veterans*