Objectives: To evaluate the survival of patients with oral cavity squamous cell carcinoma (SCC) treated with chemoradiotherapy (CRT) or radiotherapy (RT). To record the rate of osteoradionecrosis (ORN) and need for alternative feeding of patients with oral cavity cancer treated with CRT or RT. To document the Health Related Quality of Life (HRQOL) of patients with oral cavity squamous cell carcinoma (SCC) treated with chemoradiotherapy (CRT) and compare the HRQOL to patients with oral cavity SCC treated with conventional surgery +/- adjuvant treatment.
Materials & Methods: All patients with first presentation of oral cavity SCC treated with CRT or RT only at the Royal Brisbane and Women’s Hospital (RBWH) between 2000 and 2011 were included. Patient Demographics (Age, Sex), ACE-27 Co-morbidity index, Staging (TNM staging system), Type of Chemotherapy and Dose of RT, Overall Survival (OS) and Disease-Specific Survival (DSS), Attempt at Salvage, Development of distant metastases, Development of ORN and Success of treatment for ORN and Requirement for alternative feeding (PEG/NGT) were recorded. HRQOL was assessed by UW-QoLv4, EORTC QLQ-C30 and EORTC QLQ-HN35 questionnaires. The questionnaires were sent to all survivors. The patients treated with CRT that responded (Group A) were matched to patients treated with conventional surgery + RT/CRT (Group B) by age, sex, tumour subsite and TNM staging.
Results: 54 patients met the inclusion criteria. 1 patient died due to toxicity of treatment. The 5-year OS was 29%. The 5-year DSS was 30%. 11 patients remain alive and free of disease. The overall rate of ORN was 11% (6/54). The rate of ORN amongst survivors was 36% (4/11). 54% (29/54) of patients required alternative feeding (PEG/NGT) at some stage during treatment. Of the survivors, 27% (3/11) remain dependent on alternative feeding for nutrition. The questionnaire response rate was 72% (8/11). 16 patients completed the questionnaires (Group A: 8 patients; Group B: 8 patients). There was no statistical difference between the two groups in any of the domains of the UW-QoLv4, EORTC QLQ-C30 & QLQ-HN35. The global outcome scores for both treatment modalities in the UW-QoLv4 and EORTC QLQ-C30 were reasonably high which suggests that both treatments provide acceptable HRQOL. Group B (surgery) recorded better scores than the CRT group in all domains of the UW-QoLv4 except shoulder and anxiety. Group B (surgery) recorded better scores in all symptom scales/items of the EORTC QLQ-HN35.
Conclusion: CRT is successful in a small number of patients with oral cavity SCC. When compared to the published literature, surgery with or without post-operative RT has better survival rates. Salvage surgery does not appear to be a viable option for management of recurrence post CRT. The consequences of treatment, namely ORN and need for alternative feeding, are high. There was no statistically significant difference in HRQOL between patients with oral cavity SCC treated with conventional surgery +/- RT/CRT versus patients treated with CRT. Conventional surgery +/- RT/CRT recorded better scores in the majority of HRQOL domains including chewing, swallowing, saliva and speech; issues most important to patients with oral cavity SCC.