Prospective evaluation of outcome after transoral CO(2) laser resection of T1/T2 oral squamous cell carcinoma.

OBJECTIVE: Oral cancer is the sixth most common cancer in the world. The incidence of oral squamous cell carcinoma (OSCC) continues to be high, if not increasing. This prospective study assessed the oncological outcomes following transoral CO(2) laser resection of T1/T2 N0 OSCC. Patients' 3-year disease-specific survival and disease-free survival were evaluated.

MATERIAL AND METHODS: The patients' data included a range of clinical, operative, and histopathological variables related to the status of the surgical margins. Data collection also included recurrence, cause of death, date of death, and last clinic review. Ninety patients (64 males and 26 females) participated in this study. Their mean age at the first diagnosis of OSCC was 63.5 years. Two thirds of the patients were Caucasians. Usually patients present with an ulcer of the tongue, floor of mouth, or buccal mucosa. Current and ex-smokers represented 82.2% of the cohort, whereas current and ex-drinkers were 78.9%. Comorbidities included history of oral lichen planus, oral submucous fibrosis, immunodeficiency, oral dysplasia, or OSCC. Clinically, 81 patients had T1N0 disease and 9 had T2N0 disease.

RESULTS: Pathologic analysis revealed that nearly half of the patients had moderately differentiated OSCC, 18 moderately to poorly differentiated, and 19 poorly differentiated carcinoma. Study of the tumor margins was carried out and showed a mean of 5.7-mm depth of invasion; tumor clearance was primarily achieved in 73 patients. Recurrence was identified in 11 (12%) patients. The mean age of first diagnosis of the recurrence group was 76.4 years. The most common clinical presentation in the recurrence group was an ulcer involving the tongue or buccal mucosa; most commonly were identified in current or ex-smokers or drinkers. Recurrence was associated with clinical N-stage disease. The surgical margins in this group were also evaluated following relaser excision or surgical excision ± neck dissection. Follow-up resulted in a 3-year survival of 86.7%. Twelve patients died: 9 from noncancer-related causes, 2 from locoregional disease spread, and 1 from distant metastasis to the lungs.

CONCLUSIONS: Squamous cell carcinoma of the oral cavity has a poor overall prognosis with a high tendency to recur at the primary site and extend to involve the locoregional lymph nodes. The overall results of this study suggest that CO(2) laser is a comparable modality to other traditional interventions (surgery) in the management of low-risk (T1/T2) tumors of the oral cavity.