Kravets O. V., Fedzhaga I. P., Pivtorak V. I., Fedzhaha O. P.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The outcomes of combined treatment of 502 patients with locally advanced squamous cell carcinoma of the oral cavity (SCOC) were analyzed. 207 patients were underwent to definitive chemoradiotherapy (CRT) and, if possible, “salvage surgery”, 295 patients were underwent to surgical treatment with adjuvant radiation therapy (RT) or CLT (surgery + RT / CRT group). In 295 patients surgery included removal of the primary tumor, neck dissection and reconstruction of the postoperative oral defect by local flaps in 22 (7.5%) patients, regional flaps in 206 (69.8%), and free flaps in 62 (21.0%) patients. The surgical defects after resection of the maxilla were replaced by prosthesis in 5 (1.7%) patients.Adjuvant RT was performed in an average dose of 58.1 Gy (range, 46-60 Gy) in 190 (64.4%) patients. Adjuvant concurrent CRT was performed in 105 (35.6%) patients. In 61 (29.5%) patients with definitive CRT with a residual tumor or relapse of the disease, if possible, a “salvage surgery” was performed. It included a removal of the primary tumor with neck dissection in 34 (55.7%) patients. and in 27 (44.3%) patients it included the removal of the tumor with neck dissection and reconstruction of the defect with a vascularized flap: a pectorais musculocutaneous flap or a deltopectoralis skin and fascial flap. Analysis of patients’ survival was carried out according with the Kaplan-Mayer method. To assess the impact of several risk factors on survival the Cocks regression model of proportional risks was used. The critical level of significance in the analysis was adopted αcr. = 0.05. Having analised the survival curves, a statistically significant longer relapse-free survival was found for the surgery + RT / CRT group compared to the definitive CRT group (RR = 0.26 (95% VI 0.21 – 0.33), p <0.001 according to the log-rank criterion). “Salvage surgery” performed in some patients of definitive CRT group, did not significantly affect the overall survival rate as an independent factor in the Cocks multivariative analysis.

oral cancer, surgical treatment, salvage surgery, local, regional and free flaps, overall survival.

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«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 107-112 pages, index UDK 616.31+616.321-006.6-089

10.29254/2077-4214-2020-2-156-107-112