Kravets O. V., Fedzhaga I. P., Pivtorak V. I., Fedzhaha O. P.


About the author:

Kravets O. V., Fedzhaga I. P., Pivtorak V. I., Fedzhaha O. P.



Type of article:

Scentific article


The outcomes of combined treatment of 502 patients with locally advanced squamous cell carcinoma of the oral cavity (SCOC) were analyzed. 207 patients were underwent to definitive chemoradiotherapy (CRT) and, if possible, “salvage surgery”, 295 patients were underwent to surgical treatment with adjuvant radiation therapy (RT) or CLT (surgery + RT / CRT group). In 295 patients surgery included removal of the primary tumor, neck dissection and reconstruction of the postoperative oral defect by local flaps in 22 (7.5%) patients, regional flaps in 206 (69.8%), and free flaps in 62 (21.0%) patients. The surgical defects after resection of the maxilla were replaced by prosthesis in 5 (1.7%) patients.Adjuvant RT was performed in an average dose of 58.1 Gy (range, 46-60 Gy) in 190 (64.4%) patients. Adjuvant concurrent CRT was performed in 105 (35.6%) patients. In 61 (29.5%) patients with definitive CRT with a residual tumor or relapse of the disease, if possible, a “salvage surgery” was performed. It included a removal of the primary tumor with neck dissection in 34 (55.7%) patients. and in 27 (44.3%) patients it included the removal of the tumor with neck dissection and reconstruction of the defect with a vascularized flap: a pectorais musculocutaneous flap or a deltopectoralis skin and fascial flap. Analysis of patients’ survival was carried out according with the Kaplan-Mayer method. To assess the impact of several risk factors on survival the Cocks regression model of proportional risks was used. The critical level of significance in the analysis was adopted αcr. = 0.05. Having analised the survival curves, a statistically significant longer relapse-free survival was found for the surgery + RT / CRT group compared to the definitive CRT group (RR = 0.26 (95% VI 0.21 – 0.33), p <0.001 according to the log-rank criterion). “Salvage surgery” performed in some patients of definitive CRT group, did not significantly affect the overall survival rate as an independent factor in the Cocks multivariative analysis.


oral cancer, surgical treatment, salvage surgery, local, regional and free flaps, overall survival.


  1. Rak v Ukraini, 2017-2018. Zachvoruvanist, smertnist, pokaznyky dijalnosti onkosluzby. Buleten Nacionalnoho kancer reestru Ukrainy. 2019;20:80. [in Ukrainian].
  2. Kim D, Li R. Contemporary Treatment of Locally Advanced Oral Cancer. Curr Treat Options Oncol. 2019;20(4):32.
  3. Colevas AD, Yom SS, Pfister DG, Spencer S, Adelstein D, Adkins D, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018. J Natl Compr Canc Netw. 2018 May;16(5):479-90.
  4. Yao CMKL, Chang EI, Lai SY. Contemporary Approach to Locally Advanced Oral Cavity Squamous Cell Carcinoma. Curr Oncol Rep. 2019;21(11):99.
  5. Kirita T, Omura K. Oral Cancer: diagnosis and therapy. Springer Japan; 2015. 421 p.
  6. Bossi P, Lo Vullo S, Guzzo M, Mariani L, Granata R, Orlandi E, et al. Preoperative chemotherapy in advanced resectable OCSCC: longterm results of a randomized phase III trial. Ann Oncol. 2014;25(2):462-6.
  7. Licitra L, Grandi C, Guzzo M, Mariani L, Vullo SL, Valvo F, et al. Primary chemotherapy in resectable oral cavity cancer: a randomized clinical trial. J Clin Oncol. 2003 Jan 15;21(2):327-33.
  8. Stenson KM, Kunnavakkam R, Cohen EE, Portugal LD, Blair E, Haraf DJ, et al. Chemoradiation for patients with advanced oral cavity cancer. Laryngoscope. 2010;120(1):93-9.
  9. Elbers JBW, Al-Mamgani A, Paping D, van den Brekel MWM, Jozwiak K, de Boer JP, et al. Definitive (chemo)radiotherapy is a curative alternative for standard of care in advanced stage squamous cell carcinoma of the oral cavity. Oral Oncol. 2017;75:163-8.
  10. Gore SM, Crombie AK, Batstone MD, Clartk JR. Concurrent chemoradiotherapy compared with surgery and adjuvant radiotherapy for oral cavity squamouscell carcinoma. Head Neck. 2015;37(4):518-23.
  11. Hamoir M, Holvoet E, Ambroise J, Lengelé B, Schmitz S. Salvage surgery in recurrent head and neck squamous cell carcinoma: oncologic outcome and predictors of disease free survival. Oral Oncol. 2017;67:1-9.
  12. Philouze P, Péron J, Poupart M, Pujo K, Buiret G, Céruse P. Salvage surgery for oropharyngeal squamous cell carcinomas: a retrospective study from 2005 to 2013. Head Neck. 2017;39(9):1744-50.
  13. Awad MI, Shuman AG, Montero PH, Palmer FL, Shah JP, Patel SG. Accuracy of administrative and clinical registry data in reporting postoperative complications after surgery for oral cavity squamous cell carcinoma. Head Neck. 2015;37(6):851-61.
  14. Schwam ZG, Sosa JA, Roman S, Judson BL. Complications and mortality following surgery for oral cavity cancer: analysis of 408 cases. Laryngoscope. 2015;125(8):1869-73.
  15. Janot F, de Raucourt D, Benhamou E, Ferron C, Dolivet G, Bensadoun RJ, et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J Clin Oncol. 2008;26(34):5518-23.
  16. Matsuura D, Valim TD, Kulcsar MAV, Pinto FR, Brandão LG, Cernea CR, et al. Risk factors for salvage surgery failure in oral cavity squamous cell carcinoma. Laryngoscope. 2018;128(5):1113-9.
  17. Stathopoulos P, Smith WP. Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital. J Maxillofac Oral Surg. 2017;16(2):158-63.
  18. Sim YC, Hwang JH, Ahn KM. Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients. J Korean Assoc Oral Maxillofac Surg. 2019;45(2):83-90.
  19. Dhawan A, Duggal P, Bhullar RS, Kaur T, Sandhu A, Kaur K. Efficacy of Multimodal Therapy in the Survival Outcomes of Advanced-Stage (Stage III-Stage IV) Oral Carcinoma Patients: An Institutional Experience in Asian Indian Population. J Maxillofac Oral Surg. 2018;17(1):89- 94.

Publication of the article:

«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 107-112 pages, index UDK 616.31+616.321-006.6-089