Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma

BackgroundStandardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages...

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Autores principales:	Gunnar Wichmann, Mykola Pavlychenko, Maria Willner, Dirk Halama, Thomas Kuhnt, Regine Kluge, Tanja Gradistanac, Sandra Fest, Theresa Wald, Bernd Lethaus, Andreas Dietz, Susanne Wiegand, Veit Zebralla
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	oral squamous cell carcinoma (OSCC) head and neck cancer outcome research elective neck dissection (ND) local control (LC) distant metastasis free survival (DMFS) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/35763b4550d44981817a59d7c9325bd2
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spelling	oai:doaj.org-article:35763b4550d44981817a59d7c9325bd22021-11-10T08:10:41ZStandardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma2234-943X10.3389/fonc.2021.737080https://doaj.org/article/35763b4550d44981817a59d7c9325bd22021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.737080/fullhttps://doaj.org/toc/2234-943XBackgroundStandardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.MethodsAs MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.ResultsMost patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.ConclusionsDespite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.Gunnar WichmannMykola PavlychenkoMaria WillnerDirk HalamaThomas KuhntRegine KlugeTanja GradistanacSandra FestTheresa WaldBernd LethausAndreas DietzSusanne WiegandVeit ZebrallaFrontiers Media S.A.articleoral squamous cell carcinoma (OSCC)head and neck canceroutcome researchelective neck dissection (ND)local control (LC)distant metastasis free survival (DMFS)Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	oral squamous cell carcinoma (OSCC) head and neck cancer outcome research elective neck dissection (ND) local control (LC) distant metastasis free survival (DMFS) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	oral squamous cell carcinoma (OSCC) head and neck cancer outcome research elective neck dissection (ND) local control (LC) distant metastasis free survival (DMFS) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Gunnar Wichmann Mykola Pavlychenko Maria Willner Dirk Halama Thomas Kuhnt Regine Kluge Tanja Gradistanac Sandra Fest Theresa Wald Bernd Lethaus Andreas Dietz Susanne Wiegand Veit Zebralla Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
description	BackgroundStandardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.MethodsAs MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.ResultsMost patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.ConclusionsDespite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.
format	article
author	Gunnar Wichmann Mykola Pavlychenko Maria Willner Dirk Halama Thomas Kuhnt Regine Kluge Tanja Gradistanac Sandra Fest Theresa Wald Bernd Lethaus Andreas Dietz Susanne Wiegand Veit Zebralla
author_facet	Gunnar Wichmann Mykola Pavlychenko Maria Willner Dirk Halama Thomas Kuhnt Regine Kluge Tanja Gradistanac Sandra Fest Theresa Wald Bernd Lethaus Andreas Dietz Susanne Wiegand Veit Zebralla
author_sort	Gunnar Wichmann
title	Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
title_short	Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
title_full	Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
title_fullStr	Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
title_full_unstemmed	Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma
title_sort	standardized diagnostic workup and patient-centered decision making for surgery and neck dissection followed by risk-factor adapted adjuvant therapy improve loco-regional control in local advanced oral squamous cell carcinoma
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/35763b4550d44981817a59d7c9325bd2
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Standardized Diagnostic Workup and Patient-Centered Decision Making for Surgery and Neck Dissection Followed by Risk-Factor Adapted Adjuvant Therapy Improve Loco-Regional Control in Local Advanced Oral Squamous Cell Carcinoma

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