Post-Operative Radiotherapy for Oral SCC with Histologic Risk Factors: Are We Over-Treating?

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Timothy Liu, Benjamin Chua, Martin Batstone
PurposeThe role of post-operative radiotherapy (PORT) remains controversial for patients with low-risk oral squamous cell carcinoma (OSCC) and adverse histologic features. The aim of this study is to examine the survival benefits in the role of PORT, when compared to surgery alone, among these patients.MethodsIn a systematic review, relevant published literature was identified in the PubMed database and eligible studies were included. Predictor variables were perineural invasion (PNI), lymphovascular invasion (LVI), and unfavourable grade. Primary outcomes were patient survival and recurrence rates. Due to the heterogeneity and insufficiency of the reported data, quantitative meta-analysis was precluded. Qualitative analysis and pooled analysis on overall survival (OS) were performed on study subjects.ResultsSix eligible studies were included with a median study period of 10 years. All studies evaluated the role of PORT in pN0 OSCC subjects with PNI, and three studies on subjects with PNI in isolation. Overall, study subjects had similar treatment outcomes between PORT and non-PORT groups. In the pooled analysis of 325 subjects, PORT was not associated with an improved OS compared to surgery alone (70.3 vs. 80.2%; p = 0.059).ConclusionNo evidence was found to support the application of PORT given the indication of histologic risk factors alone. The prescription of PORT for PNI, LVI, and unfavourable grading among otherwise low-risk OSCC needs to be approached with caution in order to avoid unnecessary harm of radiation exposure.



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