Relevance of positive margins in case of adjuvant therapy of oral cancer

Relevance of positive margins in case of adjuvant therapy of oral cancer
Accepted 14 October 2003
A.F Kov?cs
International Journal of Oral & Maxillofacial Surgery

Abstract
Positive or clean surgical margins are of great prognostic interest in the surgical treatment of oral and oropharyngeal cancer with poor survival of patients burdened with positive margins. The impact of postoperative treatment modalities on the survival of these patients is debated. The relevance of positive margins was investigated in three patient populations (a group treated by surgery only, a group with postoperative polychemotherapy, and a group with a multi-modality treatment comprising postoperative radiation with concurrent chemotherapy) which were compared retrospectively. Patients treated with adjuvant regimens following resection in healthy margins had a survival advantage as compared to the surgery only group possibly due to less local relapses and longer relapse latencies. Overall disease-free survival was better in the groups with adjuvant therapy irrespective of free or positive margins. Survival rates following positive surgical margins were worse in all three groups as compared to the respective subgroups with healthy margins. A second resection in patients with positive margins, executed in the group with postoperative radiation with concurrent chemotherapy, did not result in survival improvement. Therefore, radical resection at initial surgery in healthy and clear margins remains indispensable in multi-modality treatment strategies involving surgery. The combination of healthy margins and adjuvant treatment seems to be most favorable for patient survival.

Keywords: head and neck neoplasms, multi-modal treatment, oral surgery, adjuvant chemotherapy, adjuvant radiotherapy
Department of Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Frankfurt am Main Medical School, Frankfurt am Main, Germany

Address: A. F. Kov?cs, Klinik f?r Kiefer- und Plastische Gesichtschirurgie, Uniklinik Haus 21, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Tel: +49 69 63016610; Fax: +49 69 63015644

☆ Presented in part on the 33rd annual D˜SAK meeting at Freiburg/Germany on November 19th, 2002.

PII: S0901-5027(03)00310-2

doi:10.1016/j.ijom.2003.10.015

© 2004 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Copyright © 2007 Elsevier, Inc. All rights reserved

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