Smit, K.A. (2017) Pathological surgical margins in oral cancer: Can local recurrence rates be affected by postoperative radiotherapy in regard to the pathological margin status? – a systematic review. thesis, Dentistry.
Full text available on request.Abstract
Oral squamous cell carcinoma (OSCC) needs to be excised surgically, in one piece, with a free (negative) pathological resection margin of 5 millimeters to reduce the chance of tumor recurrence at the primary site (local recurrence). When pathological resection margins are close (1-5 mm) or positive (<1 mm) postoperative adjuvant radiotherapy (PORT) can be given to reduce the chance on local recurrence. Treatment management is often based on hospital protocols. In literature, it remains unclear whether PORT reduces local recurrence rates with the assessment of the resection margins. Since PORT can cause serious acute and chronic side effects, its usage needs to be supported by sufficient data. The objective of this systematic review is to determine whether local recurrence rates for OSCC are affected by PORT when pathological margins are positive (<1 mm), close (1-5mm) or negative (>5 mm). Inclusion criteria were oral subsite, squamous cell carcinoma, pathological surgical resection margins, pathological T-stage, local recurrence, and sample size had to be bigger than ten (N>10). Exclusion criteria were studies describing tumors of the lip, oropharynx, larynx, base of the tongue and/or tonsils, pilot studies or case reports, no or unclear description for T-stage, surgical margins, and recurrence. The criteria were multidisciplinary discussed. From a search in three databases 2120 unique papers were screened on title and abstract. Two hundred twelve full-text papers were assessed for eligibility. After the reference check a total of 13 studies were included for qualitative synthesis. Four studies gave answer to the primary outcome. All included studies are retrospective cohort studies of moderate or poor quality. Insufficient evidence is available to determine whether local recurrence rates of oral cancer are affected by administration of PORT when pathological margins are positive, close or negative. Relative risk (RR) was calculated based on the numbers from the manuscripts; PORT seems to have an adverse effect on local recurrence rates. This was an unexpected outcome which possibly can be explained by confounding by indication. In order to assess the outcome a meta-analysis is needed. This was not possible with the available data due unmentioned data, unclear definitions and usage of different treatment modalities. This systematic review can support future prospective cohort studies concerning this matter.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Witjes, Dr. M.J.H. |
| Faculty: | Medical Sciences |
| Date Deposited: | 18 Nov 2021 11:29 |
| Last Modified: | 22 Nov 2021 11:25 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2802 |
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