Oral Cavity Squamous Cell Carcinoma at the Oral Tongue Subsite with Early Locoregional Recurrence After Curative-Intent Surgery
Clinical Scenario
This protocol applies to patients with oral cavity squamous cell carcinoma (OSCC) who develop early locoregional recurrence following curative-intent surgery. The scenario is defined by pathological features that place patients at higher risk of recurrence, with the oral tongue subsite being a central risk factor.
High-Risk Features Defining This Population
The following pathological characteristics are associated with higher risk of early locoregional recurrence in OSCC:
Oral tongue subsite
pT3–T4 category
pN2–N3 category
Microscopic positive resection margin
Postoperative head and neck imaging prior to radiation therapy planning is recommended for patients with these high-risk features.
Salvage Strategy — Partial Overview
When early locoregional recurrence is identified, management involves a salvage approach. This may include additional surgery where technically feasible, and/or intensified radiation therapy — with concurrent systemic therapy considered for patients who are fit to receive it. The complete eligibility criteria, sequencing, and treatment details are available in the full protocol.
References
DOI: 10.1200/EDBK_389810
- Oral tongue subsite, pT3-4 category, pN2-3 category, and microscopic positive resection margin were the risk factors for developing early recurrence.
- Postoperative head and neck imaging before RT planning is recommended for patients with OSCC and higher risk of early recurrence (eg, oral tongue subsite, pT3-4 category, pN2-3 category, and microscopic positive resection margins).
- Salvage treatment options include (1) additional revision surgery (if feasible); (2) use of intensified radiation by planning higher total radiation dose, higher radiation dose per fraction (hypofractionation), or accelerated PORT schedules; and/or (3) addition of adjuvant systemic therapy concurrently with PORT.
- The use of high-dose accelerated hypofractionated PORT (70 Gy/33 fractions, 66 Gy/30 fractions, or equivalent) with concurrent cisplatin (for patients who were fit [and agreed] to receive chemotherapy) in patients with OSCC and early recurrence has resulted in a successful salvage rate of 36% at 5 years after PORT.
- Treatment intensification with high-dose accelerated hypofractionated RT and concurrent cisplatin (for fit patients) could provide a successful salvage option for early recurrence in approximately one third of patients.
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