Preoperative vs. postoperative radiochemotherapy in patients with N2 squamous cell carcinoma of the oral cavity.

BACKGROUND: The aim of our study was to evaluate retrospectively whether neoadjuvant or adjuvant radiochemotherapy yields better survival for patients with N2-oral squamous cell carcinoma and to identify subgroups, which may benefit from one of the therapeutic settings. No studies have been carried out to investigate whether radiochemotherapy should be applied before or after surgery.

METHODS: In total, 151 patients with oral squamous cell carcinoma with N2-nodal-status were reviewed. Eighty five patients received neoadjuvant radiochemotherapy, 66 patients were treated with surgery and adjuvant radiochemotherapy. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis.

RESULTS: Patients treated with neoadjuvant radiochemotherapy had a significantly improved 5-year survival in comparison to patients, who received adjuvant radiochemotherapy (46.3% vs. 27.4%, p=0.035). A subgroup analysis by T-stage revealed that neoadjuvant and adjuvant radiochemotherapy yielded similar 5-year survival rates for patients with T2N2-tumors (42.3% vs. 41.2%, p=0.871), whereas patients with T4bN2-tumors significantly benefitted from neoadjuvant treatment (37.3% vs. 9.7%, p=0.019).

CONCLUSIONS: Neoadjuvant radiochemotherapy is an effective treatment for patients with nodal status N2-oral squamous cell carcinoma, however prospective randomized trials are needed to confirm, which patients should be treated with neoadjuvant or adjuvant radiochemotherapy.