3647 - Oral Cavity Carcinoma with Persistent or Rapidly Progressive Disease after Surgical Resection: Outcomes of Additional Therapy

C. A. Fan¹, R. Duggal¹, D. S. Buchberger², A. Nag³, R. W. Davis², S. A. Koyfman², N. Silver⁴, E. Lamarre⁴, S. R. Campbell³, J. A. Miller³, J. Scharpf⁴, J. Ku⁴, J. L. Geiger⁵, T. Sussman⁶, E. Yilmaz⁷, B. Prendes⁴, and N. M. Woody²; ¹Cleveland Clinc, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, ²Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, ³Cleveland Clinic, Cleveland, OH, ⁴Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, ⁵Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, ⁶Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, ⁷Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH

Purpose/Objective(s): The prognosis of patients with early progressive disease following surgical resection for oral cavity carcinoma is not well established. In this study, we evaluate patient, treatment, and outcome characteristics of patients with gross disease found in within 3 months of surgical resection. Materials/Methods: We queried an IRB-approved registry of head and neck cancer patients at a tertiary care center to identify patients with non-metastatic oral cavity carcinoma undergoing primary surgical resection between 2010 and 2020. Patients with gross disease in the head and neck following surgery, either during radiation planning or within 3 months postoperatively if RT was not employed, were included. Patients were stratified by locoregional only or metastatic disease. Pre- and post-op imaging was reviewed to determine if, after direct comparison with imaging at the time of disease identification, gross disease was present before surgery but not radiologically recognized at the time (persistence) versus those with a rapid progression. One-way ANOVA and Chi-square were used for univariate analysis of normal continuous and categorical variables, respectively, while Kruskal-Wallis was used for non-normal continuous variables. Cox-proportional hazards model was used to analyze time-to-event data and Kaplan Meier for actuarial survival estimates.

Results: Of 528 oral cavity carcinoma patients, 43 (8.1%) were identified to have persistent (n=10) or progressive (n=27) disease. Imaging was not adequate to classify the status of 6 patients. 42 patients had squamous cell histology, of which two were sarcomatoid, and 1 adenocarcinoma. The progressive group had a slightly higher prevalence of pT3-4 patients than the persistent group (63% vs 40% p=0.29). 8 patients had synchronous distant metastatic disease, and survival outcomes were poorer for this group (12-month actuarial survival of 79% (95% CI 66%, 94%) vs 33% (95% CI 13%, 84%)). Among patients with locoregional only disease, radiation dose was escalated to higher than 66Gy in 24 (83%), one patient received additional surgery (3.4%), one received immunotherapy (3.4%) in addition to other treatments, and concurrent chemotherapy was added for 11 (38%) of cases in which it would not have been otherwise indicated. 12 and 24-month actuarial survival among non-metastatic persistent and progressive disease patients was 75% (61%, 93%) and 52% (36%, 75%).

Conclusion: A small number of patients will have gross disease in the first 3 months after surgery for oral cavity cancer, and close attention is needed at time of radiation planning. Patients with locoregional only disease can have reasonable disease control, often requiring escalation of adjuvant treatment. Those with synchronous metastatic disease have a limited life expectancy.