Treatment Results and Prognostic Factors for Locally Advanced Buccal Cancer

Feng-Chun Hsu ^a, Tze-Ta Huang ^b, Wen-Yen Chiou ^a, Ching-Chih Lee ^{c, e}, Moon-Sing Lee ^{a, e}, Shih-Hsuan Hsiao ^c, Hon-Yi Lin ^{a, e}, Yu-Chieh Su ^{d, e}, Shih-Kai Hung ^{a, e}

^aDepartment of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^bDepartment of Oral and Maxillofacial Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^cDepartment of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^dDepartment of Hematological Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^eSchool of Medicine, Tzu Chi University, Hualien, Taiwan

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Abstract

Objective
The aim of this study was to retrospectively analyze locally advanced buccal cancer in order to determine tumor characteristics and any other prognostic factors that may influence the survival of patients with the disease.
Patients and Methods
The records of 54 patients with stage III to IV locally advanced buccal cancer (TNM system) who were seen from August 2000 to June 2008 at one institution were reviewed. The patients received radical surgery and then adjuvant treatment. The adjuvant treatment in cluded concurrent chemoradiotherapy or radiotherapy alone. The chemotherapy protocol consisted of two 4-weekly courses of concurrent cisplatin and 5-fluorouracil followed by another two 4-weekly courses after radiotherapy, with regimens of cisplatin (60–100 mg/m2/day) on day 1 and 5-fluorouracil (1000 mg/m2/day) on days 1–5.
Results
The 3-year cumulative overall survival, disease-specific survival, disease-free survival, locoregional control, and distant metastasis-free survival rates were 66%, 69%, 58%, 65%, and 92%, respectively. Univariate analysis indicated that the pN classification, the surgical margin, and the presence of extracapsular spread were significantly associated with overall survival. On multivariate analysis, pN classification and surgical margin significantly affected disease-free survival. The pN classification (pN0 vs. pN1–3) and the surgical margin (< 1 vs.≥ 1 mm) were the two most significant factors affecting clinical outcome.
Conclusion
The presence of lymph node involvement, the presence of extracapsular spread and a surgical margin < 1 mm were strong prognostic factors that were associated with tumor control. More aggressive postoperative therapy is suggested for patients with buccal mucosa carcinoma if these factors exist.

Keywords

Buccal cancer; Concurrent chemoradiation; Prognostic factors