The Failure of Initial Treatment for TNM Stage Ⅰ & Ⅱ Squamous Cell Carcinomas of the Oral Cavity

Korean Journal of Head & Neck Oncology 2005;21(1):26-31.
Published online May 30, 2005.

Hyun Seok Lee;Han Sin Jeong;Tae Wook Kim;Young lk Son;Chung Hwan Baek

조기(TNM Stage Ⅰ & Ⅱ) 구강 편평세포암종의 초치료 실패

이현석;정한신;김태욱;손영익;백정환

Abstract

Backgrounds and Objectives: Squamous cell carcinomas of the oral cavity(SCOC) in TNM stage I & II have relatively high chance to be cured compared to those in the advanced stage, but sometimes result in the treatment failure with poor prognosis. There have been few reports on the patterns of failure and the clinical courses for SCOC in stage I & II after the failure of initial treatment. This study is directed at identifying the clinical outcomes of stage I & II SCOC and the salvage rate after initial treatment and suggesting an optimal level of treatment by analyzing the patterns of failure. Material and Methods: The medical records of 36 patients with SCOC, initially diagnosed between 1995 and 2001 as TNM stage I & II were reviewed retrospectively. The patterns of failure, salvage treatment, clinical courses, and the survival of these subjects were analyzed. The minimum follow-up period of no-evidence of disease(NED) was 12 months with an average of 32.2 months.
Results
Overall rate of the treatment failure in SCOC of stage I & II was 41. 7%(15/36 cases). Most of the treatment failure in the subjects with stage I tumors occurred in regional lymph node. Local failure was the most frequent form of failure in the subjects with stage II tumors after wide excision of primary tumor with elective neck dissection and/or radiation therapy. No significant correlation was noted between the safety margin and the local failure. Elective neck dissections in stage I & II SCOC had a tendency to reduce regional failure (p=0.055). The salvage rates at 24 months were 85.7% in stage I, and 37.5% in stage II. The 3-year survival rate after the failure of initial treatment was 55.0%.
Conclusion
SCOC of stage I & II after the failure of initial treatment showed poor prognosis despite of the salvage treatments. This study implies that the elective neck dissections for regional lymph node should be required for SCOC of stage I & II to reduce the treatment failure.

Key Words: Treatment failure, Squamous cell carcinoma, Oral cavity