In patients with locally recurrent carcinomas of the oral cavity and oropharynx, a disease-free interval of more than 1 year and tumor tissue negative for EGFR (epidermal growth factor receptor) expression predict a good response to salvage surgery.
That's the conclusion of physicians in Brazil who studied the outcomes of 111 patients following salvage surgery for locally recurrent squamous cell carcinomas of the oral cavity and oropharynx at Hospital A. C. Camargo in Sao Paulo.
Local recurrence in such patients carries a poor prognosis, and clinical factors alone are insufficient for identifying those who would benefit from further treatment, Dr. Luiz Paulo Kowalski and associates note in their paper in the July issue of the Archives of Otolaryngology–Head and Neck Surgery. They therefore analyzed the prognostic significance of EGFR, matrix metalloproteinases 2 and 9, and vascular endothelial growth factor expression.
In multivariate analysis, disease-free survival and EGFR expression status were the only variables associated with an independent significantly high risk of death. Patients with a disease-free interval of less than 1 year (hazard ratio 1.97) and those with overexpression of EGFR (HR 4.20) had the worst prognosis.
In their suggested treatment algorithm for patients with resectable local recurrence, Dr. Kowalski's group recommends surgery for all patients with a disease-free interval of > 1 year and for those with clinical stage I or II. They also believe that surgery is worthwhile for patients with higher stage tumors if they are EGFR-negative.
They suggest other options for those with stage III/IV cancer who are EGFR-positive, including palliation, best supportive care, EGFR target therapy, or surgery plus EGFR target therapy.
Arch Otolaryngol Head Neck Surg 2008;134:743-749.
Reviewed by Ramaz Mitaishvili, MD
