Why surgery over RT IN EARLY ORAL CANCER

1. WHY SURGERY SHOULD BE
PREFERRED OVER
RADIOTHERAPY IN EARLY ORAL
CANCERS?
DR. ABHIJEET SINGH
SURGICAL ONCOLOGY
AIIMS

6. Original R
esearch
Primar y Surgery vs Radiotherapy for
Early Stage Oral Cavity Cancer
Otolaryngology–
Head and Neck S
urgery
1–11
Ó American Academy of
Otolaryngology—Head and Neck
S
urgery Foundation 2017
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DOI: 10.1177/0194599817746909
http://otojour nal.org
Mark A. Ellis, MD1
, Evan M. Graboyes, MD1
,
Amy E. W ahlquist, MS2
, David M. Neskey, MD1
,
John M. Kaczmar, MD3
, Heather K. Schopper 1
,
Anand K. Sharm a, MD4
, Patrick F. Morgan, MD1
,
Shaun A. Nguyen, MD1
, and Terr y A. Day, MD1
S
ponsorships or competing interests that may be relevant to content are dis-
closed at the end of this article.
Abstr act
Objective. The goal of this study is to determine the effect of
primary surgery vs radiotherapy (RT) on overall survival
(OS
) in patients with early stage oral cavity squamous cell
carcinoma (OCS
CC). In addition, this study attempts to
identify factors associated with receiving primary R
T.
S
tudy Design. Retrospective cohort study.
S
etting. National Cancer Database (NCDB, 2004-2013).
S
ubjects and Methods. Reviewing the NCDB from 2004 to
2013, patients with early stage I to II OCS
CC were identi-
fied. Kaplan-Meier estimates of survival, Cox regression
Received August 23, 2017; revised October 24, 2017; accepted
November 18, 2017.
O
ral cavity squamous cell carcinoma (OCSCC) is th
most common malignancy of the upper aerodigestiv
tract.1
Approximately 50% of patients with OCSCC
present with early stage disease (American Joint Commission
on Cancer [AJCC] stages I-II).2
,3
Primary surgery is consid
ered the standard of care for early stage OCSCC4
-7
and is th
‘‘preferred’’ treatment modality according to the 2017
National Comprehensive Cancer Network (NCCN) guidelines.
However, the NCCN guidelines also allow for definitive radio
therapy (RT) as an alternative primary treatment modality.8
I
is known that primary RT for OCSCC results in high rates o
osteoradionecrosis.9
,1
0
Whether primary RT is associated with
http://otojournal.org
Mark A. Ellis, MD1
, Evan M. Graboyes, MD1
,
Amy E. Wahlquist, MS2
, David M. Neskey, MD1
,
John M. Kaczmar, MD3
, Heather K. Schopper1
,
Anand K. Sharma, MD4
, Patrick F. Morgan, MD1
,
Shaun A. Nguyen, MD1
, and Terry A. Day, MD1
Sponsorshipsor competing intereststhat mayberelevant tocontent aredis-
closed at theendof thisarticle.
Abstract
Objective. The goal of thisstudy isto determine the effect of
primary surgery vs radiotherapy (RT) on overall survival
(OS) in patients with early stage oral cavity squamous cell
carcinoma (OCSCC). In addition, this study attempts to
identify factorsassociated with receivingprimary RT.
StudyDesign. Retrospectivecohort study.
Setting. National Cancer Database (NCDB, 2004-2013).
Subjects and Methods. Reviewing the NCDB from 2004 to
2013, patients with early stage I to II OCSCC were identi-
Received August 23, 2017; revised October 24, 2017; accepted
November 18, 2017.
O
ral cavity squamous cell carcinoma (OCSCC)
most common malignancy of the upper aerodi
tract.1
Approximately 50% of patients with O
present with early stage disease (American Joint Comm
on Cancer [AJCC] stages I-II).2,3
Primary surgery is c
ered the standard of care for early stage OCSCC4-7
and
‘‘preferred’’ treatment modality according to the
National ComprehensiveCancer Network (NCCN) guide
However, theNCCN guidelines also allow for definitive
therapy (RT) as an alternative primary treatment modal
is known that primary RT for OCSCC results in high r

9. CASE SCENARIO

10. PHYSICIAN VS SURGEON

11. SURGERY RESULTS

12. RADIOTHERAPY RESULTS

13. TEAM APPROACH

14. THANK YOU

17. • Mohmadi, 63ys F
• UHID: 20190007943
• Presented with
- h/o burn x 1year back
- growth over left thigh x 2 months
(insidious and gradually progressing, a/w
pain and difficulty while limb movements)
• No known comorbidities

18. • General and systemic examination- WNL
• Local examination-
- UPG ~ 25x 15 cm over anterior and lateral aspect of
thigh
- Foul-smell pus discharge present
- No inguinal LNs palpable

20. • Blood investigations –
WNL
• HPE (S-211/19) : Mod.
Differentiated SCC

23. • MOHAN LAL, 75 YEARS, M
• UHID: 2018027166
• PRESENTED WITH PAIN IN ABDOMEN X 3 MONTHS
- MILD, ON- AND-OFF
- F/B FEVER (MILD, ON AND OFF) 2-3 DAYS LATER
- SHARP PAIN AROUND RIGHT SIDE OF UMBILICUS,
WHICH TURNED INTO DIFFUSE PAIN ALL OVER
ABDOMEN
- A/W LOOSE STOOLS, 3-4 TIMES/DAY

24. • UNDERWENT USG (OUTSIDE) 23/11/18: HYPOECHOIC
MASS WITH ECHOGENIC SHADOW IN RIGHT ILIAC
REGION (?APPENDICULAR/ ? GIT MASS)
• CT ABDOMEN (OUTSIDE) 23/11/18 :
CIRCUMFERENTIAL WALL THICKENING IN CAECUM
AND ASCENDING COLON
- S/O ? NEOPLASTIC LESION
• REFERRED TO AIIMS RISHIKESH
• UNDERWENT COLONOSCOPY WITH BIOPSY (12/12/18):
ULCERATIVE MUCOSA IN ASCENDING COLON ?
MALIGNANT ? IBD ? TB

25. • HPE (S-4033/18): INCONCLUSIVE
• REPEAT COLONOSCOPY WITH BIOPSY (11/01/19):
STRICTURE OVER HEPATIC FLEXTURE @ 65CM FROM
ANAL VERGE; NO OBVIOUS GROWTH
• HPE (S-168/19)- S/O GRANULATION TISSUE
• REPEAT CT (18/01/19): DIFFUSE, IRREGULAR
CIRCUMFERENTIAL ENHANCING WALL THICKENING
INVOLVING DISTAL ILEUM, TERMINAL ILEUM, ICJ,
PROXIMAL PART OF ASCENDING COLON, RIGHT
HEPATIC FLEXURE AND PROXIMAL TRANSVERSE COLON
(MAX THICKNESS 9 MM)