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• W4220729490 abstract "Purpose/Objective(s) While surgical margins are considered one of the most critical prognostic factors in the management of oral tongue cancer, controversy exists regarding the value of additional resection of a positive main specimen margin. Furthermore, the use of frozen sections is not standardized and varies amongst institutions. Our primary objective was to investigate the impact of immediate resection of a positive margin on local control of oral tongue cancer. A secondary objective was to evaluate the utility of tumor bed margins in predicting the status of the main specimen margin. Materials/Methods A retrospective analysis of all oral tongue cancers treated at a NCI-designated comprehensive cancer center between 2013 and 2018 was performed (n=273). Tumors were resected en bloc, and intraoperative frozen tumor bed margins were performed in most patients (n=256). The main specimen was inspected by the surgeon, and additional resection during the initial surgery was performed if deemed necessary by inspection of the main specimen and/or frozen sections. Positive margins were defined as invasive carcinoma or high-grade dysplasia at or < 1mm from the inked edge of the main specimen. Based on re-resection status, main specimen margins were further divided into the following groups: negative; positive with re-resection; and positive without re-resection. Cox proportional hazards models were first used to assess univariate associations between potential predictors and local recurrence free survival (RFS). Variables with p<0.05 were then entered into multivariable models for RFS. The Kaplan-Meier estimate was used to calculate RFS rate. Results The rate of positive main specimen margin was 17.9% (49/273). Of the patients with positive margins, 38.8% (19/49) underwent immediate re-resection of the margin. Local recurrence rate was 7.7% (21/273). In the multivariable model, independent predictors of local recurrence included advanced T stage (T4a vs T1, HR 9.3 [95% CI 1.9-45.2], p=0.006) and positive margin without re-resection (vs negative margin, HR 2.8 [95% CI 1.0-7.7], p=0.041). Five-year RFS was 0.91 for patients with negative margins, 0.92 for positive margins with re-resection, and 0.73 for positive margins without re-resection. The rate of positive tumor bed frozen margin was 7% (18/256), and the sensitivity of intraoperative tumor bed margins in detecting a positive main specimen margin was 17.4% (8/46). Conclusion Our data demonstrates that, in patients with a positive main specimen margin, immediate targeted resection achieved local control rates comparable to patients with a negative margin. Without additional resection, positive margins were associated with poorer local control. Thus, intraoperative evaluation of the surgical margin with immediate targeted resection during the initial surgery plays a critical role in the management of oral tongue cancer. While surgical margins are considered one of the most critical prognostic factors in the management of oral tongue cancer, controversy exists regarding the value of additional resection of a positive main specimen margin. Furthermore, the use of frozen sections is not standardized and varies amongst institutions. Our primary objective was to investigate the impact of immediate resection of a positive margin on local control of oral tongue cancer. A secondary objective was to evaluate the utility of tumor bed margins in predicting the status of the main specimen margin. A retrospective analysis of all oral tongue cancers treated at a NCI-designated comprehensive cancer center between 2013 and 2018 was performed (n=273). Tumors were resected en bloc, and intraoperative frozen tumor bed margins were performed in most patients (n=256). The main specimen was inspected by the surgeon, and additional resection during the initial surgery was performed if deemed necessary by inspection of the main specimen and/or frozen sections. Positive margins were defined as invasive carcinoma or high-grade dysplasia at or < 1mm from the inked edge of the main specimen. Based on re-resection status, main specimen margins were further divided into the following groups: negative; positive with re-resection; and positive without re-resection. Cox proportional hazards models were first used to assess univariate associations between potential predictors and local recurrence free survival (RFS). Variables with p<0.05 were then entered into multivariable models for RFS. The Kaplan-Meier estimate was used to calculate RFS rate. The rate of positive main specimen margin was 17.9% (49/273). Of the patients with positive margins, 38.8% (19/49) underwent immediate re-resection of the margin. Local recurrence rate was 7.7% (21/273). In the multivariable model, independent predictors of local recurrence included advanced T stage (T4a vs T1, HR 9.3 [95% CI 1.9-45.2], p=0.006) and positive margin without re-resection (vs negative margin, HR 2.8 [95% CI 1.0-7.7], p=0.041). Five-year RFS was 0.91 for patients with negative margins, 0.92 for positive margins with re-resection, and 0.73 for positive margins without re-resection. The rate of positive tumor bed frozen margin was 7% (18/256), and the sensitivity of intraoperative tumor bed margins in detecting a positive main specimen margin was 17.4% (8/46). Our data demonstrates that, in patients with a positive main specimen margin, immediate targeted resection achieved local control rates comparable to patients with a negative margin. Without additional resection, positive margins were associated with poorer local control. Thus, intraoperative evaluation of the surgical margin with immediate targeted resection during the initial surgery plays a critical role in the management of oral tongue cancer." @default.
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• W4220729490 date "2022-04-01" @default.
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• W4220729490 title "Management of Positive Main Specimen Margin in Oral Tongue Cancer" @default.
• W4220729490 doi "https://doi.org/10.1016/j.ijrobp.2021.12.036" @default.
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