Mortality and Causes of Death After Multimodality Treatment for Advanced Oral and Oropharyngeal Cancer

Mortality and Causes of Death After Multimodality Treatment for Advanced Oral and Oropharyngeal Cancer
February 2007
Arno Wutzl, MD, DMD⁎, Oliver Ploder, MD, DMD, PhD‹, Christian Kermer, MD, DMD·, Werner Millesi, MD, DMD, PhD?, Rolf Ewers, MD, DMD, PhD∥, Clemens Klug, MD, DMD, PhD
Journal of Oral and Maxillofacial Surgery

Purpose
To analyze mortality and causes of death in patients who received preoperative radiochemotherapy and underwent radical surgery for advanced oral or oropharyngeal cancer.

Patients and Methods
A total of 222 patients who underwent multimodality treatment from 1990 to 2000 were included in the study. The inclusion criterion was International Union Against Cancer (UICC) disease stage II to IV (T2, 33.3%; T3, 12.6%; T4, 54.1%). Patients received preoperative radiotherapy 50 Gy and concomitant chemotherapy with mitomycin and 5-fluorouracil. Radical localÒregional en bloc resection was performed in all patients. Survival status and causes of death were ascertained from the National Health Registry. Death certificates and autopsy reports were consulted when hospital files failed to provide reliable data.

Results
After a median surveillance period of 72.3 months (range, 24 to 152 months), 59% of patients were alive, 21% had died of recurrence, 5% had died perioperatively, and 15% had died from other causes. Of these, a second cancer in the head and neck region or the lower respiratory tract or the upper digestive tract was found in 7.3%. Although 93% of deaths related to recurrent disease occurred within the first 36 months after surgery, the remaining causes of death did not reveal a specific temporal pattern.

Conclusion
Favorable survival data were registered for patients with advanced squamous cell carcinoma of the oral cavity who underwent combined treatment protocols. These patients frequently die of comorbidities. Because recurrent disease is a less common cause of mortality than are other causes, the latter should receive attention during surveillance.

⁎ Registrar in Oral and Maxillofacial Surgery, University Hospital Vienna, Vienna, Austria.

‹ Professor and Department Head, Department of Oral and Maxillofacial Surgery, Hospital Feldkirch, Feldkirch, Austria.

· Assistant Professor, University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria.

? Professor and Department Head, Department of Oral and Maxillofacial Surgery, Hospital Lainz, Vienna, Austria.

∥ Professor and Department Head, University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria.

? Assistant Professor, University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria.

Address correspondence and reprint requests to Dr Wutzl: University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria

The ethical committee of the Medical University of Vienna approved this study.

This study was supported by the ÏJubilâumsfonds der ˜sterreichischen Nationalbank,Ó project no. 10701 (coordinated by Dr Clemens Klug). The ethical committee of the Medical University of Vienna approved this study.

PII: S0278-2391(06)01760-5

doi:10.1016/j.joms.2006.09.007

© 2007 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Copyright © 2007 Elsevier, Inc. All rights reserved

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