To evaluate overall survival (OS), disease-free survival (DFS), and locoregional control in patients with pT3–T4 pN0 oral cavity squamous cell carcinoma (OSCC) treated with surgery and postoperative radiotherapy (PORT) confined to the primary tumor bed, particularly focusing on the implications of omitting neck irradiation.
Approach:
Study Design: A retrospective single-center cohort study including patients with pT3–T4 pN0 OSCC treated between January 2009 and December 2019.
Treatment Protocol: Patients underwent resection of the primary tumor and neck dissection (ND), followed by PORT to the primary tumor bed without neck irradiation.
Data Collection: Clinical and pathological data were collected from electronic medical records and a regional cancer database.
Outcome Measures: Primary endpoints included OS, DFS, and regional control (RC).
Statistical Analysis: Descriptive statistics and Kaplan-Meier methods were used to estimate survival outcomes.
Key Findings:
The study included a homogeneous cohort of patients with advanced OSCC and pN0 status.
Postoperative neck irradiation was omitted based on high-quality neck dissection and low risk of residual disease.
The number of lymph nodes retrieved during neck dissection was a significant factor in determining the need for postoperative neck irradiation.
Interpretation:
The findings suggest that selective omission of postoperative neck irradiation may be feasible in certain pN0 patients with advanced OSCC, potentially reducing treatment-related morbidity.
Limitations:
The study is retrospective and conducted at a single center, which may limit the generalizability of the findings.
The evidence supporting the omission of postoperative neck irradiation is limited and varies across studies.
Conclusion:
The study highlights the need for further investigation to identify which patients may safely benefit from a de-escalated postoperative radiation strategy.
