Issue N# 3 - 2007
Outcome of surgical and adjuvant radiotherapy treatment of T3-T4 squamous cell carcinoma of the floor of the mouth: evaluation of oncological control and treatment related morbidity
Authors : Hitter A, Soriano E, Bettega G, Karkas A, Reyt E, Righini C. A (Grenoble)
Ref. : Rev Laryngol Otol Rhinol. 2007;128,3:155-162.
Article published in french
Downloadable PDF document french
Objective: The aims of this study were to evaluate the therapeutic outcome and morbidity associated with management of squamous cell carcinoma (SCC) T3-T4 of the floor of the mouth. Patients and Methods: This was a retrospective study (1993 and 2005). Inclusion criteria were: 1) Presence of a locally advanced (T3-T4) lesion of the floor of the mouth; 2) Pathological confirmation of SCC; 3) No previous treatment of the floor of the mouth; 4) Absence of any synchronous lesions at the primary endoscopic work-up; 5) Absence of distant metastasis outside the aero-digestive tract; 6) Karnofsky performance index >70. All patients were treated by surgery and adjuvant radiotherapy. The statistical analysis was conducted using the stat-view software; categorical variables were compared using the Fisherís exact test; analysis of recurrence-free survival rate was done following the Kaplan-Meier method, and the log-rank test was used for the comparison of survival graphs. Results: Fourty-seven patients were included in this study (42 men), of a mean age of 53.3 years. The majority of patients (93.6%) presented with a stage IVa tumour, and no clinical evidence of cervical lymphadenopathy in 60% of cases. All patients underwent bilateral neck dissection adapted to the cervical lymph node status. Forty-one (87%) patients underwent partial mandibulectomy with fibula free-flap reconstruction in 32 cases (78%). Early local complication rate was of 32%. The mean duration of hospitalization was 34 days. Late local complication rate was of 17%. The immediate post-operative death rate was 2%. The rate of survival and recurrence free survival was of 47.5% and 47% respectively. The 3 survival-influencing factors were age (p= 0.02), margins of surgical resection (p= 0.002), and histologic cervical lymph node status (p= 0.03). Conclusion: T3-T4 tumours of the floor of the mouth are managed by surgical resection and adjuvant radiotherapy. There is a high rate of treatment-associated complications. The prognosis of locally advanced tumours of the floor of the mouth remains humble.
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