0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Efficacy of Induction Selection Chemotherapy vs Primary Surgery for Patients With Advanced Oral Cavity Carcinoma

Steven B. Chinn, MD, MPH1; Matthew E. Spector, MD1; Emily L. Bellile, MS2; Laura S. Rozek, PhD3; Tasha Lin, BS1; Theodoros N. Teknos, MD1,4; Mark E. Prince, MD1,5; Carol R. Bradford, MD1,5; Susan G. Urba, MD5,6; Thomas E. Carey, PhD1,5; Avraham Eisbruch, MD5,7; Gregory T. Wolf, MD1,5; Francis P. Worden, MD5,6; Douglas B. Chepeha, MD, MSPH1,5
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
2Comprehensive Cancer Center Biostatistics Unit, University of Michigan, Ann Arbor
3Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor
4now with Department of Otolaryngology–Head and Neck Surgery, Ohio State University Medical Center, Columbus
5Comprehensive Cancer Center, University of Michigan, Ann Arbor
6Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
7Department of Radiation Oncology, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2014;140(2):134-142. doi:10.1001/jamaoto.2013.5892.
Text Size: A A A
Published online

Importance  The University of Michigan has investigated the use of induction selection (IS) with chemoradiotherapy (CRT) for patients who respond to CRT and found this approach effective in the management of advanced laryngeal cancer. The IS approach was extended to oral cavity squamous cell carcinoma (OCSCC) to help understand whether organ preservation or survival benefit resulted.

Objective  To evaluate the efficacy of an IS protocol vs primary surgical extirpation and selective postoperative radiotherapy for advanced OCSCC.

Design and Setting  Retrospective matched cohort study at a tertiary care hospital.

Participants  Nineteen patients with resectable stages III and IV OCSCC were enrolled into a phase 2 IS trial. Patients with a response of at least 50% underwent concurrent CRT; those with a response of less than 50% underwent surgical treatment and radiotherapy. A comparison cohort of patients treated with primary surgical extirpation during a similar time period was frequency matched for inclusion criteria and patient characteristics to those patients included from the phase 2 IS trial. No difference was noted in age, sex, pretreatment American Joint Committee on Cancer stage, T and N classifications, smoking status, alcohol consumption, or tumor subsite between the IS and surgical cohorts. Median follow-up was 9.4 years in the IS cohort and 7.1 years in the surgical cohort.

Interventions  Induction selection and CRT vs primary surgical extirpation with or without postoperative radiotherapy.

Main Outcomes and Measures  Overall and disease-specific survival and locoregional control.

Results  The Kaplan-Meier estimate for overall survival at 5 years was 32% in the IS cohort and 65% in the surgical cohort. The Kaplan-Meier estimate for disease-specific survival at 5 years was 46% in the IS cohort and 75% in the surgical cohort. The Kaplan-Meier estimate for locoregional control at 5 years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better overall and disease-specific survival and locoregional control outcomes (P = .03, P = .001, and P < .001, respectively) in the surgical cohort.

Conclusions and Relevance  Primary surgical treatment showed significantly better survival and locoregional control compared with IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol vs primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Treatment Schema

A, Induction selection cohort. B, Primary surgical cohort. CRT indicates chemoradiotherapy; DL/Bx, direct laryngoscopy and biopsy; OCSCC, oral cavity squamous cell carcinoma; and PORT, postoperative radiotherapy.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Descriptive Outcomes

A, Induction selection cohort. B, Surgical cohort. CRT indicates chemoradiotherapy; DOD, died of disease; NED, no evidence of disease; and PORT, postoperative radiotherapy.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Kaplan-Meier Survival Curves for the Surgical Cohort and Induction Selection (IS) Cohort

A, Overall survival (P = .01). B, Disease-specific survival (P = .001). C, Locoregional control (P < .001). Analyses include 19 patients in the IS cohort and 53 in the surgery cohort.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Kaplan-Meier Survival Curves for Subcohort Analysis of Induction Selection Responders (ISR) and Nonresponders (ISNR) Compared With Surgical Cohort

A, Overall survival. B, Disease-specific survival. C, Locoregional control. Analyses include 10 patients in the ISR subcohort, 9 in the ISNR subcohort, and 53 in the surgery cohort. P values for pairwise comparisons are given in Table 5.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();