A longitudinal study of outcomes and patterns of failure in postoperative gingivo-buccal oral squamous cell carcinoma treated with concurrent chemotherapy and intensity modulated radiotherapy

Sweta Sharma, Tej Prakash Soni, Nidhi Patni


This study aims to determine the outcomes and patterns of failure in gingivo-buccal oral squamous cell carcinoma (OSCC) after postoperative intensity modulated radiotherapy (IMRT) with concurrent chemotherapy. A prospective single-arm study was conducted at our institute from October 2014 to June 2016. Fourty-two patients with postoperative gingivo-buccal OSCC (stage III/IV) intended for curative treatment by IMRT and concurrent chemotherapy were analysed. The median prescribed dose was 60 Gy (range 60–66 Gy). At median follow-up of 12 months, the 1-year loco-regional control (LRC) rate was 95.24%. Two (4.76%) patients experienced recurrence in local and regional areas, respectively. Both the patients showed in-field pattern of recurrence. No marginal or out-of-field recurrence was observed. Four (9.52%) patients failed distantly. The 1-year loco-regional recurrence free survival (LRRFS), distant metastasis free survival (DMFS) and overall survival (OS) estimates were 95.24%, 90.48% and 97.62%, respectively. None of the prognostic factors retained in the model as independent significant predictor for LRRFS, DMFS and OS (p > 0.05) on multivariate analysis. Although increasing age, pT3–4, lymphovascular invasion (LVI), extracapsular extension (ECE), depth of invasion >4 mm, grade 2–3 and ryles tube insertion were associated with higher hazards ratio. Acute grade 2 mucositis and dermatitis toxicity were experienced by 54.76% and 42.86%, respectively. Late grade 2 xerostomia and trismus were experienced by 28.57% and 35.71%, respectively. Improvement in mean quality of life (QOL) score assessed by FACT-HN questionnaires was found to be statistically significant (p < 0.01). IMRT, as an adjuvant treatment, is effective for gingivo-buccal OSCC with acceptable toxicities and also significantly improved mean QOL score over period of time after treatment. Most failures were in-field failures. Further clinical studies are necessary to improve the outcomes of patients with high risk features.


head and neck cancer; gingivo-buccal oral cancer; IMRT; outcomes; patterns of failures

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DOI: http://dx.doi.org/10.30564/amor.v3i6.142


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