|Cancer of the buccal mucosa: are margins and T-stage
accurate predictors of local control?
Sieczka E, Am J Otolaryngol. 2001 Nov-Dec;22(6):395-9.
Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263,
Cancer of the buccal mucosa is an uncommon and aggressive neoplasm of the oral cavity.
Less than 2% of patients treated for cancer of the oral cavity at Roswell Park Cancer
Institute (RPCI) from 1971 to 1997 had primary buccal cancers. Because the majority of
these patients did not undergo any adjuvant treatment, this group provided us with the
opportunity to assess the relationship between margin status and local recurrence for both
small (T1-T2) and large (T3-T4) tumors treated with surgery alone. MATERIALS AND METHODS:
The RPCI tumor registry database reported 104 patients who were treated for buccal
carcinoma. A retrospective chart review identified 27 patients who met our criteria for a
buccal mucosal primary tumor (epicenter of the mass in the buccal mucosa). There were 13
men and 14 women, ranging in age from 34 to 94 years (mean, 75). Data were collected
regarding patient demographics, presenting symptoms, stage, treatment received, and
outcome. RESULTS: All patients underwent surgical resection of their primary lesion; 21
(75%) had T1 or T2 tumors. The rate of local recurrence was 56% for the group as a
whole. Patients with close or positive margins had a 66% local failure rate as compared
with 52% when surgical margins were negative (greater than or equal to 5 mm from the
resection margin after tissue fixation; P = ns). Among those
in whom negative margins were achieved, patients with T1-T2 disease had a 40% local
failure rate with surgical resection alone. CONCLUSIONS: Local excision of T1
and T2 buccal mucosa cancers with pathologically negative margins had a high rate of local
recurrence in our series. Low T-stage and negative margins are not adequate predictors of
local control. Even early buccal tumors may benefit from adjuvant
therapy to enhance local control.
Squamous cell carcinoma
of the buccal mucosa.
Strome SE, Otolaryngol Head Neck Surg. 1999 Mar;120(3):375-9.
Department of Otolaryngology, Mayo Clinic, Rochester, USA.
The purpose of this study was to establish treatment criteria for patients with
early-stage squamous cell carcinoma of the buccal mucosa. Thirty-one patients were
analyzed in a retrospective fashion. Distribution of patients according to tumor stage was
relatively even. Within 5 years recurrent disease developed in nearly 80% of evaluable
patients. There was a 100% overall incidence of local disease
recurrence for patients with stage I and II tumors treated with wide local excision alone
and followed up for more than 2 years. On the basis of these data, we conclude that wide local excision for early-stage buccal carcinoma
is associated with a high local failure rate. Possible causes for failure and
alternative treatment approaches are discussed.
Radiotherapy of carcinoma of the buccal mucosa.
Chaudhary AJ, Semin Surg Oncol. 1989;5(5):322-6.
Department of Radiation Oncology, Tata Memorial Hospital, Bombay, India.
A retrospective study of 399 cases of buccal cancer, presenting to the Tata Memorial
Hospital, Bombay, during January to December 1984 was undertaken to define the efficacy of
various treatment modalities in different clinical stages. Analysis of treatment technique
and response was carried out in 185 cases that completed adequate therapy. Sixty percent
of patients with stage I and II disease (21/35) received radiation therapy alone as the
primary modality of treatment. Patients (150) with stage III or IV disease received
palliative irradiation (57 cases), radical surgery (54 cases), or a combination of both
(39 cases). The 2-year disease-free survival (DFS) rates were 48% for radiotherapy and 46%
for surgery in the early stages and 5% and 33%, respectively, for advanced stages.
Radiotherapy with a modified technique is recommended for the early-stage cancers and
preoperative irradiation with adjuvant chemotherapy or hyperthermia for the advanced
Carcinoma of the buccal mucosa.
Chhetri DK, Otolaryngol Head Neck Surg. 2000 Nov;123(5):566-71.
Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90095, USA.
The goal was to analyze the outcome of surgical therapy for buccal carcinoma.Twenty-seven
patients received first-time surgical therapy for buccal carcinoma. Treatment was surgery
alone in 15 and surgery followed by radiation therapy in 6 patients. Six additional
patients received surgical salvage for radiation therapy failure. Composite resection of
the tumor was performed in 16 patients (59%). Five-year observed actuarial survival
rates were 100%, 45%, 67%, and 78%, and locoregional recurrence rates were 0%, 27%, 44%,
and 0% for stages I to IV, respectively. The 5-year actuarial survival rates were 80%
after surgery and 82% after surgery and postoperative radiation therapy. Patients who
underwent surgical salvage after radiation therapy failure had a 1-year survival rate of
0%. CONCLUSION: Aggressive surgical treatment of buccal carcinoma may result in better
Squamous cell carcinoma of the buccal mucosa: one institution's
experience with 119 previously untreated patients.
Diaz EM Jr, Head Neck. 2003 Apr;25(4):267-73.
The Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer
Squamous cell carcinoma (SCC) of the buccal mucosa is a rare, but especially
aggressive, form of oral cavity cancer, associated with a high rate of locoregional
recurrence and poor survival. We reviewed our institution's experience with 119
consecutive, previously untreated patients with buccal SCC. METHODS: We reviewed the
charts of 250 patients who were seen at The University of Texas M. D. Anderson Cancer
Center between January, 1974, and December, 1993. Of these, 119 were untreated and were
subsequently treated exclusively at our institution. Patients with T1- or T2-sized
tumors had only a 78% and 66% 5-year survival, respectively. Muscle invasion, Stensen's
duct involvement, and extracapsular spread of involved lymph nodes were all associated
with decreased survival (p <.05). Surgical salvage for patients with locoregional
recurrence after radiation therapy was rarely successful. CONCLUSIONS: SCC of the buccal
mucosa is a highly aggressive form of oral cavity cancer, with a tendency to recur
locoregionally. Patients with buccal mucosa SCC have a worse stage-for-stage survival rate
than do patients with other oral cavity sites.
Surgery versus surgery and postoperative radiotherapy in squamous cell
carcinoma of the buccal mucosa: a comparative study.
Dixit S, Ann Surg Oncol. 1998 Sep;5(6):502-10.
Department of Radiation Oncology, The Gujarat Cancer and Research Institute, Ahmedabad,
The efficacy of postoperative radiotherapy for squamous cell carcinoma of the buccal
mucosa was evaluated. One hundred seventy-six patients treated between 1989 and 1993 were
analyzed. One hundred fifteen patients were treated with surgery alone (Group 1), and 61
patients were treated with a combination of surgery and postoperative radiotherapy (Group
2). RESULTS: Actuarial 3-year locoregional control in Groups 1 and 2 was 11% and 48% for
patients with stage III + IV cancer (P = .001) and 71% and 75% for patients with stage I +
II cancer (P = .74), respectively. On multivariate analysis for locoregional failure,
surgical margin, bone invasion, high grade, and node involvement were significant factors
in Group 1, whereas in Group 2 only tumor thickness was a significant factor. For local
failure, margin, bone invasion, and stage in Group 1 and tumor thickness in Group 2
appeared as significant factors. For nodal failure, clinical nodal (cl N0 vs. N+) stage
and grade in Group 1 and pathologic nodal stage (pN0 + 1 vs. pN2) in Group 2 were observed
as significant factors. On subset analysis, postoperative radiotherapy was observed to
have a significant advantage for surgical margins of 2 mm or less in both early pT (T1 +
T2) (P = .019) and late pT (T3 + T4) (P = .016) stages. The local failure rate was higher
if the time between surgery and radiotherapy was greater than 30 days. CONCLUSIONS: Postoperative radiotherapy was effective in decreasing
locoregional failure in patients with close surgical margins, tumor thicker than 10 mm,
high-grade tumors, positive node, and bone invasion. The effect of interval between
surgery and postoperative radiotherapy on local failure was margin-dependent.
Combined-modality therapy for squamous carcinoma of the buccal
mucosa: treatment results and prognostic factors.
Fang FM, Head Neck. 1997 Sep;19(6):506-12.
Department of Radiation Oncology, Chang Chang Gung Memorial Hospital-Kaohsiung, Chang Gung
Medical College, Taoyuan, Kaohsiung, Hsien, Taiwan.
Reports on locoregional control and survival of squamous cell carcinoma of buccal mucosa
are scarce in literature. In this study, a single institutions's experience of combined
surgery and postoperative radiotherapy (RT) for buccal mucosal malignancy with favorable
results was analyzed and presented. The prognostic factors on locoregional control were
also discussed. METHODS: From January 1988 to July 1994, 57 patients with squamous cell
carcinoma of buccal mucosa treated by surgery and RT were reviewed. The distributions
according to American Joint Committee on Cancer (AJCC) staging were: stage II, 6; stage
III, 21; and stage IV, 30 patients. Total dose of RT at the buccal area ranged from 45 Gy
to 68.4 Gy, median 61.2 Gy. Tumor-related factors (AJCC stage, T stage, histologic
grading, pathologic tumor invasion to skin of cheek, adjacent bony structures, and
regional lymph nodes) and treatment-related factors (surgical margin, radiation dose, and
the time interval between operation and RT) were analyzed to determine their influence on
locoregional control. RESULTS: Three-year actuarial locoregional control rate, overall
survival rate, and disease-specific survival rates were 64%, 55%, and 62%, respectively.
Ten of these 22 patients (45%) with recurrent tumors were reoperated, but only 2 patients
were successfully salvaged. Positive surgical margin and tumor invasion to skin of cheek
were significantly poor prognostic factors on locoregional control by univariate analysis.
In multivariate analysis, tumor invasion to skin of cheek was the only prognostic factor
(p = .0014). CONCLUSIONS: Locoregional failure was the major cause of death for squamous
buccal mucosa cancers managed with surgery and RT. Few recurrences could be detected early
and successfully salvaged. Skin of cheek involvement is an important prognostic factor for
buccal mucosa cancers.
Post-operative radiotherapy in carcinoma of buccal mucosa, a
prospective randomized trial.
Mishra RC, Eur J Surg Oncol. 1996 Oct;22(5):502-4.
A.H. Regional Centre for Cancer Research and Treatment, Orissa, India.
Squamous cell carcinoma of the buccal mucosa is a common cancer in India. We are referred
a large number of locally advanced lesions where curative surgery is still possible. The
objective of this study is to determine the role of post-operative radiotherapy in
enhancing disease-free survival. Patients with stages III and IV cancer of the buccal
mucosa potentially curable by surgery were randomized to surgery only or post-operative
radiotherapy. Patients were followed up for 3 years. The clinico-pathological features
in both arms were comparable. Disease-free survival at the end of
the study was found to be 38% and 68% (P<0.005) respectively. Post-operative
radiotherapy was thus seen to improve disease-free survival in squamous cell carcinoma of
the buccal mucosa.
Evaluation of the role of radiotherapy in the management of
carcinoma of the buccal mucosa.
Nair MK, Cancer. 1988 Apr 1;61(7):1326-31.
Regional Cancer Centre, Medical College Campus, Kerala, India.
Carcinoma of the buccal mucosa is the commonest intraoral malignancy in south India. This
article concerns the results of radiotherapy in cancer of the buccal mucosa. Radiotherapy
was used as the first line of management in this series and surgery was reserved for
failures even though very few patients opted for salvage surgery. Of the 234 evaluable
patients, 42% survived disease-free at the end of 3 years with radiotherapy alone. Eighty-five
percent of the patients with Stage I, 63% with Stage II, 41% with Stage III, and 15% with
Stage IV disease survived disease-free at 3 years. With radium implant and
small-volume beam-directed external radiotherapy, the survival rates were similar (62%
versus 64%). The results of external radiation in advanced disease were dismal. Persistent
disease after radiotherapy was a serious problem in advanced stages, especially in view of
nonacceptance of salvage surgery by a significant proportion of patients. The most
effective way of improving cure rates in cancer of the buccal mucosa seems to be early
Evaluation of treatment results of squamous cell carcinoma of the
Pop LA, Int J Radiat Oncol Biol Phys. 1989 Feb;16(2):483-7.
Dept. of Radiotherapy, Dr. Daniel den Hoed Cancer Center, Rotterdam Radio-Therapeutic
Institute, University Hospital Dijkzigt, The Netherlands.
Of the 49 patients with squamous cell carcinoma of the buccal mucosa referred to the
Rotterdam Radio-Therapeutic Institute (RRTI) and Universital Hospital Dijkzigt Rotterdam
(AZD) during 1970-1984, 31 patients had an advanced stage of disease, 21 patients had
clinical evidence of lymph node metastasis. Forty patients were treated with curative
intention. Treatment modalities were: radiation therapy, preoperative radiation followed
by surgery, and primary surgery. Eighteen of the 40 patients (45%) developed a local tumor
recurrence; nearly all recurrences occurred within 2 years. The incidence was equal in all
treatment groups. Of the 22 patients with initial clinically negative neck, regional
relapse occurred in 3 of the 14 patients, of whom the neck was not treated electively by
radiation therapy; all three in combination with a local recurrence. None of the 8
patients with electively irradiated necks developed a regional relapse. Eight of the 18
patients with initial clinically enlarged lymph nodes treated either by radiotherapy or
surgery, developed a regional relapse, 5 in combination with a local recurrence. Treatment
of the clinically positive neck by neck dissection was superior to radiotherapy. Local
recurrence carried a poor prognosis. Almost 70% died of their disease. The overall and
corrected 5-year survival was 38% and 52% respectively.