Strahlentherapie und Onkologie

, Volume 185, Issue 5, pp 296–302

Outcome and Histopathologic Regression in Oral Squamous Cell Carcinoma after Preoperative Radiochemotherapy

  • Oliver Driemel
  • Tobias Ettl
  • Oliver Kölbl
  • Torsten E. Reichert
  • Bernd V. Dresp
  • Jürgen Reuther
  • Hans Pistner
Original Article

Background and Purpose:

Preoperative radiochemotherapy has been reported to enhance tumor response and to improve long-term survival in advanced squamous cell carcinoma of the head and neck. This retrospective study evaluates regression rate and long-term survival in 228 patients with primary oral squamous cell carcinoma treated by neoadjuvant radiochemotherapy and radical surgery.

Patients and Methods:

All patients with biopsy-proven, resectable oral squamous cell carcinoma – TNM stages II–IV without distant metastasis – received preoperative treatment consisting of fractioned irradiation of the primary and the regional lymph nodes with a total dose of 40 Gy and additional cisplatin (n = 160) or carboplatin (n = 68) during the 1st week of treatment. Radical surgery and neck dissection followed after a delay of 10–14 days. The study only included cases with histologically negative resection margins.


After a median follow-up of 5.2 years, 53 patients (23.2%) had experienced local-regional recurrence. The median 2-year disease-specific survival (DSS) rate was 86.2%. 5-year DSS and 10-year DSS were 76.3% and 66.7%, respectively. Complete histological local tumor regression after surgery (ypT0) was observed in 50 patients (21.9%) and was independent of pretreatment tumor classification. Uni- and multivariate survival analysis revealed that ypT- and ypN-stage were the most decisive predictors for DSS.


Preoperative radiochemotherapy with cisplatin/carboplatin followed by radical surgery attains favorable long-term survival rates. This applies especially to cases with complete histological tumor regression after radiochemotherapy, which can be assumed for one of five patients.

Key Words:

Oral squamous cell carcinoma Preoperative radiochemotherapy Cis-/carboplatin Histological regression Survival 

Behandlungsergebnisse und histopathologische Regression bei oralen Plattenepithelkarzinomen nach neoadjuvanter Radiochemotherapie

Hintergrund und Ziel:

Die präoperative simultane Radiochemotherapie soll die lokale Tumorkontrolle erhöhen und das Gesamtüberleben beim Plattenepithelkarzinom des Kopf-Hals-Bereichs verbessern. Hierzu wurden retrospektiv die Regressionrate und das Langzeitüberleben bei 228 Patienten mit primären oralen Plattenepithelkarzinomen, die durch neoadjuvante Radiochemotherapie und radikale Tumorresektion behandelt wurden, untersucht.

Patienten und Methodik:

Bei 228 Patienten mit bioptisch-histologisch gesicherten, operablen oralen Plattenepithelkarzinomen – TNM-Stadien II–IV ohne Fernmetastasen (Tabelle 1) – wurde eine präoperative Bestrahlung des Primärbefunds und der regionalen Lymphknoten mit einer Gesamtdosis von 40 Gy bei zusätzlicher Gabe von Cisplatin (n = 160) oder Carboplatin (n = 68) in der 1. Woche durchgeführt. Im Anschluss folgten die radikale Tumor- und Lymphknotenresektion. In die Analyse wurden lediglich Fälle mit histologisch negativen Resektionsrändern eingeschlossen.


Nach einer medianen Beobachtungszeit von 5,2 Jahren war es bei 53 Patienten (23,2%) zu einem Lokalrezidiv gekommen. Die mittlere tumorspezifische 2-Jahres-Überlebensrate lag bei 86,2%, das 5- und 10-Jahres-Überleben bei 76,3% bzw. 66,7% (Abbildung 1). Eine histologisch komplette lokale Tumorregression im Resektionspräparat (ypT0) konnte bei 50 Patienten (21,9%) festgestellt werden, unabhängig von der präoperativen Tumorgröße (Tabellen 2 und 3). In der uni- und multivariaten Analyse erwiesen sich ypT und ypN als wichtigste prognostische Parameter (Abbildung 2, Tabelle 4).


Die präoperative Radiochemotherapie mit Cisplatin/Carboplatin und nachfolgender Tumorresektion erzielt hohe Langzeitüberlebensraten (Tabelle 5). Dies gilt insbesondere in Fällen kompletter histologischer Tumorregression nach Radiochemotherapie, welche bei einem von fünf Patienten zu beobachten ist.


Orales Plattenepithelkarzinom Neoadjuvante Radiochemotherapie Cis-/Carboplatin Histologische Regression Überleben 


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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Oliver Driemel
    • 1
    • 5
  • Tobias Ettl
    • 1
  • Oliver Kölbl
    • 2
  • Torsten E. Reichert
    • 1
  • Bernd V. Dresp
    • 3
  • Jürgen Reuther
    • 3
  • Hans Pistner
    • 4
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Hospital RegensburgRegensburgGermany
  2. 2.Department of RadiotherapyUniversity Hospital RegensburgRegensburgGermany
  3. 3.Department of Oral and Maxillofacial SurgeryUniversity Hospital WürzburgWürzburgGermany
  4. 4.Department of Oral and Maxillofacial SurgeryHelios Hospital ErfurtErfurtGermany
  5. 5.Klinik und Poliklinik für Mund-, Kiefer- und GesichtschirurgieKlinikum der Universität RegensburgRegensburgGermany

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