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Definitive radiotherapy vs. postoperative radiotherapy for lower gingival carcinomas of the mandible

A single-center report about outcome and toxicity

Definitive Radiotherapie vs. postoperative Radiotherapie von Gingivakarzinomen im Bereich des Unterkieferknochens

Einzelzentrumanalyse des Gesamtüberlebens und der posttherapeutischen Toxizität

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Abstract

Purpose

To assess radiotherapy (RT) outcomes in patients with gingival carcinoma and growth up to or involvement of the lower jaw bone.

Methods

This was a retrospective analysis of 51 patients with squamous cell carcinomas of the gingiva. Patients received definitive (group 1, 31.4%) or postoperative (group 2, 66.7%) RT between 2005 and 2017 at the Department of Radiation Oncology, University Hospital Heidelberg. The primary endpoint was overall survival (OS) in both treatment groups. Other endpoints were local-disease-free survival (LDFS), progression-free survival (PFS) and treatment-related toxicity (Common Terminology Criteria for Adverse Events, CTCAE, Version 4.03).

Results

Median age at first diagnosis was 63 years. All patients had a local advanced disease (American Joint Commission on Cancer [AJCC] stage III–IV). After a median follow-up of 22 months (range 3–145 months), 20 patients (39.2%) were still alive. At 5 years, OS rate was 36.6%. No significant differences in OS (p = 0.773), PFS (p = 0.350) and LDFS (p = 0.399) were observed between the two groups. Most common higher-grade acute RT-related complications (≥ grade 3) were dermatitis (78.2%), oral mucositis (61.7%), xerostomia (51.5%), and loss of taste (74.6%). Three cases (5.8%) of osteoradionecrosis (ORN) of the lower jaw were detected after 15–31 months.

Conclusions

Definitive and postoperative RT have similar treatment outcomes for patients with lower gingiva carcinomas of the lower jaw. The most common acute complications (grade ≥3) were dermatitis, oral mucositis, xerostomia and loss of taste.

Zusammenfassung

Zielsetzung

Ziel war die Analyse von Effektivität, Nebenwirkungen sowie Rezidivwahrscheinlichkeit nach Radiotherapie (RT) von Patienten mit Gingivakarzinomen mit Wachstum in Richtung des Unterkieferknochens oder Infiltration desselben.

Methoden

Es erfolgte eine retrospektive Auswertung von 51 Patienten mit Plattenepithelkarzinomen des Zahnfleisches. Patienten erhielten entweder eine definitive (Gruppe 1; 31,4%) oder postoperative (Gruppe 2; 66,7%) RT im Zeitraum von 2005 bis 2017 in der Abteilung für Strahlentherapie des Universitätsklinikums Heidelberg. Der primäre Endpunkt war die Analyse des Gesamtüberlebens (OS) in beiden Behandlungsgruppen. Weitere Endpunkte waren das lokalrezidivfreie Überleben (LDFS), das progressionsfreie Überleben (PFS) sowie die Erfassung von behandlungsassoziierten Nebenwirkungen (gemäß Common Terminology Criteria for Adverse Events, CTCAE, Version 4.03).

Ergebnisse

Das mediane Patientenalter bei Erstdiagnose war 63 Jahre. Alle Patienten wiesen ein lokal fortgeschrittenes Karzinom auf (Stadium III–IV nach AJCC, American Joint Commission on Cancer). Nach einem medianen Follow-up von 22 Monaten (min. 3 Monate, max. 145 Monate) lebten noch 20 Patienten (39,2%). Das 5‑Jahres-Überleben betrug 36,6%. Es zeigte sich im gesamten Kollektiv kein signifikanter Überlebensvorteil bezüglich OS (p = 0,773), PFS (p = 0,350) und LDFS (p = 0,399). Die meisten akuten Toxizitäten (Grad 3–4) zeigten sich als Radiodermatitis (78,2%), Mukositis (61,7%), Mundtrockenheit (51,5%) und Geschmacksverlust (74,6%). Bei 3 Patienten (5,8%) entwickelte sich eine Osteoradionekrose des Unterkiefers in einem Zeitraum von 15–31 Monaten nach RT.

Schlussfolgerung

Sowohl die definitive als auch adjuvante RT von Gingivakarzinomen des Unterkiefers zeigen vergleichbare Ergebnisse bezüglich Gesamtüberleben, lokaler Kontrolle und Toxizität. Die häufigsten akuten Nebenwirkungen (≥ Grad 3) umfassten Radiodermatitis, Mukositis, Mundtrockenheit und Geschmacksverlust.

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Acknowledgements

We thank our Head and Neck Cancer Research Group members for their great effort. Additionally, we thank the NCT Cancer Registry for providing basic patient and treatment data and the HIRO Research Database team for data management support. The data were presented in part at the 24th Annual Meeting of the German Society of Radiation Oncology; June 21-24, 2018, Leipzig, Germany. The poster’s abstract has been published [58].

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Kristin Lang, Sati Akbaba, Thomas Held, Nina Bougatf, Denise Bernhardt, Stefan Rieken, Jürgen Debus & Sebastian Adeberg MD

  2. Heidelberg Institute of Radiation Oncology (HIRO), 69120, Heidelberg, Germany

    Kristin Lang, Sati Akbaba, Thomas Held, Nina Bougatf, Denise Bernhardt, Stefan Rieken, Jürgen Debus & Sebastian Adeberg MD

  3. Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Steffen Kargus, Dominik Horn & Kolja Freier

  4. Heidelberg Ion Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany

    Denise Bernhardt, Stefan Rieken, Jürgen Debus & Sebastian Adeberg MD

  5. Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Jürgen Debus & Sebastian Adeberg MD

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  1. Kristin Lang
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  2. Sati Akbaba
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  3. Thomas Held
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  11. Sebastian Adeberg MD
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Contributions

KL and SA developed and planned the retrospective analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sebastian Adeberg MD.

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Conflict of interest

K. Lang, S. Akbaba, T. Held, S. Kargus, D. Horn, N. Bougatf, D. Bernhardt, K. Freier, S. Rieken, J. Debus and S. Adeberg declare that they have no competing interests.

Ethical standards

The Heidelberg Ethics Committee approved this study. Because of the retrospective design, informed consent was not required.

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The data used in this analysis are from publications available in the public domain.

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Lang, K., Akbaba, S., Held, T. et al. Definitive radiotherapy vs. postoperative radiotherapy for lower gingival carcinomas of the mandible. Strahlenther Onkol 195, 819–829 (2019). https://doi.org/10.1007/s00066-019-01484-z

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