Comparison of clinical outcome and quality of life between definitive radiotherapy and postoperative radiotherapy for oral cavity and oropharyngeal cancer patients

Abstract

Purpose: To evaluate which one is the better treatment strategy by comparing clinical outcome and complication of postoperative radiotherapy (RT) and definitive RT in carcinoma of oral cavity or oropharynx. Material and methods: Fifty-five patients with oral cavity cancer and 62 patients with oropharyngeal cancer patients treated with definitive or postoperative RT between January 2006 – August 2008 were retrospectively analyzed. The median follow-up time was 34 (range 4-70) months and the median age was 57 (range 26-85). Number of patients with stage IV was 18 of 26 (69%) patients in definitive group and 63 of 91 (69%) in postop group. The portion of intensity-modulated RT was 69% (18 patients) in definitive group and 59% (54 patients) in postop group (p=0.014), but total radiation dose was not significantly different (median dose 70Gy vs. 63Gy, p=0.465). Chemotherapy was applied to 84.6% (22 patients) in definitive group and 8% (7 patients) in postop group. To assess patients’ quality of life, information of complaint during treatment and follow-up after the treatment were collected.Results: Between 2 groups, there were no significant differences in 3-year local control rate (81% vs. 87%, p=0.945) and 3-year progression-free survival (77% vs. 68%, p=0.16). Treatment-related dysphagia (85% vs. 36%, p<0.001) was worse in definitive group significantly and treatment-related xerostomia (35% vs. 56%, p=0.054) tended to be worse in postop group. In late complication, xerostomia (40% vs. 37%, p=0.968) and dysgeusia (19% vs. 7%, p=0.144) showed no difference between 2 groups, but 41% (23 of 56 patients) of patients with reconstruction suffered from flap-related complication. There was no late dysarthria in definitive group while 12% (8 patients) in postoperative group experienced it.Conclusions: In oral cavity or oropharyngeal cancer, definitive RT showed comparable clinical outcome and complication rate compared to major surgery and postoperative RT. As non-invasive treatment modality, definitive RT may replace major surgery in oral cavity and oropharyngeal carcinoma.