Preoperative Radiotherapy Does Not Increase the Risk for Early Complications Following Surgery for Oral Cancer: A...

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Management of complications after oral cavity squamous cell carcinoma (OCSCC) surgery is challenging.
• Conflicting results exist regarding complication risks after preoperative radiotherapy (RT), necessitating further investigation.
• A randomized controlled trial (RCT) was designed to address these uncertainties.

Purpose of the Study:

• To compare early hospitalization complications for OCSCC surgery between patients receiving preoperative accelerated fractionated RT and those not yet exposed to RT.
• To evaluate the impact of preoperative RT on surgical outcomes, including wound infection, flap necrosis, and fistula formation.
• To provide evidence-based guidance for OCSCC treatment protocols.

Main Methods:

• A multicentre RCT (ARTSCAN 2) involving 221 untreated, resectable OCSCC patients across 6 Swedish hospitals.
• Patients were divided into two groups: 103 received preoperative accelerated RT (68 Gy, twice daily, 4-6 weeks before surgery) and 118 were not yet exposed to RT.
• Early complications during hospitalization, surgical length, blood loss, and transfusions were monitored.

Main Results:

• Complication rates were low and showed no statistically significant differences between the preoperative RT group and the unirradiated group.
• Wound infection rates were 11.7% (preoperative RT) vs. 7.6% (unirradiated), P=.31.
• Free flap necrosis occurred in 2.5% (preoperative RT) vs. 5.8% (unirradiated), P=.63, with no significant difference in oro/pharyngocutaneous fistula rates (2.9% vs. 2.5%, P=1.00).

Conclusions:

• Preoperative accelerated RT at 68 Gy, administered 4-6 weeks prior to surgery, does not elevate early postoperative complication risks in OCSCC patients.
• While survival, quality of life, and societal costs require further assessment, current findings indicate that preoperative RT does not negatively impact early surgical outcomes.
• These results support the integration of preoperative RT into OCSCC management without increasing immediate surgical morbidity.