Impact of radical treatments on survival in locally advanced T4a and T4b buccal mucosa cancers: Selected surgically treated T4b cancers have similar control rates as T4a.

INTRODUCTION: In the absence of any robust data supporting the TNM classification of T4 buccal mucosa cancers, we did this prospective study to compare the oncologic outcomes of T4a and T4b buccal mucosa cancer patients. PATIENTS AND METHODS: This is a prospective study of 210 treatment naïve T4 buccal mucosa cancer patients. All patients underwent upfront radical surgery followed by adjuvant radiotherapy (RT)/chemoradiotherapy (CCRT). This is the largest prospective series in the literature on T4 buccal cancers. RESULTS: T4a disease was seen in 135(64.3%) patients and T4b in 75(35.7%) patients. On comparison between all T4a and T4b cases, a significant difference was observed with regard to 3-year local control (49.6% vs. 41.1%: p-0.025) and disease-free survival (DFS) (65.3% vs. 42%: p-0.035) with a slightly higher incidence of distant metastasis in T4b patients (17.3% vs. 9.6%). Inadequate cut margin (<5 mm) was seen only in 7.4% patients with T4a disease and 12% patients with T4b disease. When patients with adequate cut margins were considered for analysis, local recurrence rate was similar for T4a (26/135; 19.3%) and T4b (15/66; 22.7%) disease suggesting the importance of radical surgery in infra-notch T4b buccal cancers. While the 3-year survival for T4a patients who received adjuvant RT alone was 72.2%, it was only 42.1% for similar T4b patients suggesting a need to intensify adjuvant treatment for these patients. CONCLUSION: Surgery should be considered as the primary modality of treatment for T4b patients, where clear margins are achievable. The benefit of treatment intensification with adjuvant CCRT should be explored in T4b buccal cancers.

Longitudinal and cross-sectional assessment of quality of life in surgically treated advanced (T4) cancer of the buccal mucosa.

OBJECTIVE: Quality of life (QOL) has become an important aspect of today's health care management. This study performed longitudinal assessment of QOL in patients with advanced cancers of the buccal mucosa (T4). We compared the QOL between patients who received adjuvant chemoradiation therapy (CTRT) and that of patients who received radiation therapy alone and assessed whether baseline QOL can predict disease recurrence. STUDY DESIGN: This was a prospective study of 225 patients with T4 buccal mucosal cancer. Health-related QOL was assessed at baseline and at 3, 6, 9, and 12 months after completion of treatment by means of the European Organization for Research and Treatment of Cancer Core QOL Questionnaire and the HN35 questionnaire. RESULTS: There was persistent improvement in global QOL and pain. Emotional functioning improved at 12 months. Most of the head and neck-specific symptoms deteriorated at 3 months, with subsequent improvement at 12 months except in swallowing, senses, speech, social eating, social contact, and sexuality. Patients who received adjuvant CTRT had poorer QOL. Poorer baseline global QOL (P = .049), dyspnea (P = .04), appetite loss (P = .015), and weight loss (P = .08) may predict recurrence. CONCLUSIONS: Although there is an improvement in global QOL and pain, most of the head and neck-specific symptoms worsened in the immediate postoperative period. Adjuvant CTRT has a persistent effect on specific domains compared with adjuvant radiation therapy alone. Poor baseline QOL scores are associated with a higher risk of recurrence.