2015 Annual Meeting: http://www.aaoms.org/annual_meeting/2015/index.php

What Is the Ideal Management of Buccal Squamous Cell Carcinoma - a Rare Oral Cancer?

Scott Jones DDS Seattle, WA, USA
Jasjit K. Dillon DDS, MD, BDS, FDSRCS Seattle, WA, USA
Akashdeep Villing DMD Seattle, WA, USA
Neal Futran DDS, MD Seattle, WA, USA
Hans C. Brockhoff II DDS, MD Ann Arbor,, MI, USA
Brent B. Ward DDS, MD Ann Arbor, MI, USA
Purpose

Buccal squamous cell carcinoma (BSCC) is a rare but aggressive oral cancer in the United States, accounting for 10% of all oral cavity carcinoma. The location of it provides few anatomical barriers to spread and it has been found to have a high local and regional recurrence rate, even in the setting of negative surgical margins 1, 2.  The role of the elective neck dissection (END) in the clinically negative neck (N0) is not clear. In this study, we investigate the local, regional and distant metastasis rate and the role of END in cases of N0 BSCC.  Furthermore, one of the recommended goals from the AAOMS 2014 research summit was multi-centered collaboration. This study is the pilot data that has been collected thus far. 

Materials and Methods

A descriptive retrospective chart review was conducted of patients diagnosed with BSCC and treated at two institutions, the University of Washington and the University of Michigan during June 2001 to June 2011. The data was collected separately at the institutions, de-identified and combined for review. Categorical variables collected were patient demographics, initial surgery type, neck dissection, adjuvant therapy, pathology data and staging. The primary outcome variables were local and regional recurrence.  Secondary outcome variables were distant metastasis, 2 and 5 year survival rate. Descriptive analysis is presented. 

Results

47 subjects were identified over the study period, mean age 62 (36-86), 65% male. 38% had a local recurrence.  38% had nodal metastasis, T1 25%, T2 50%, T3 20%, T4 71%. 20 of 47 (43%) had a clinical staging of N0, and 15 of the 20 received an END. Of the 5 that did not have an END, 3 patients (60%) had a local recurrence, 1 (20%) had a regional recurrence, and 1(20%) had metastasis. Of the 15 who had an END 3 patients (20%) had local recurrence, 1 (6.67%) had regional recurrence, and 2 (13.3%) had metastasis. The 2- and 5-year survival rates for N0 patients without an END was 80% and 40%, respectively vs. 93% and 86.7% for those who did receive an END.  

Conclusions

Our study corroborates prior studies that BSCC is an aggressive cancer with a high recurrence rate. END had a therapeutic role with a lower regional recurrence rate. 2- and 5- year survival rates were higher for those who had an END.  Our next goal is to collect the data from the other OMS Head and Neck centers in the USA to enable a detailed descriptive and statistical analysis with increased power for this rarer oral malignancy. 

1 Lin, Chun-Shu, Yee-Min Jen, Ming-Fang Cheng, Yaoh-Shiang Lin, Wan-Fu Liu, Jing-Min Hwang, Li-Ping Chang, Hsing-Lung Chao, Dai-Wei Liu, Hon-Yi Lin, and Weng-Toon Shum. "Squamous Cell Carcinoma of the Buccal Mucosa: An Aggressive Cancer Requiring Multimodality Treatment." Wiley InterScience (2005): 151-57. 30 Sept. 2005. Web. 

2 Diaz, Eduard M., F. C. Holsinger, Edgar R. Zuniga, Dianna B. Roberts, and Douglas M. Sorensen. "Squamous Cell Carcinoma of the Buccal Mucosa: One Institution's Experience with 119 Previously Untreated Patients." Wiley InterScience (2002): 267-73. Print.