February 23, 2007 (Miami)— Survival is significantly increased in patients with squamous cell carcinoma when treated with surgery plus adjuvant hormone- and/or chemotherapy compared with patients receiving radiation plus adjuvant therapy, according to research presented here at the 2007 annual meeting of the American College of Preventive Medicine.

In a cross-sectional study, Hossein Farsad, MD, a resident in preventive medicine and public health at the Palm Beach County Health Department in Florida, and colleagues analyzed more than 5000 cases of squamous cell carcinoma, occurring between January 1, 1981, and December 31, 2002. The data were obtained from the Florida Cancer Data System.

A total of 5923 cases were included in the analysis, of which a large majority (n = 5742) underwent surgery followed by chemo- and/or hormone therapy, while the remaining patients (n = 181) were treated with radiation instead of surgery. The researchers estimated the relative risk (RR) of death using the Mantel-Haenszel method for stratified analysis. An RR for survival of 2.61 (95% confidence interval, 2.33 - 2.92; P < .05) was found for the surgery and adjuvant therapy group compared with the radiation and adjuvant therapy group.

These results mean that the chances of survival are increased by more than 2.5 times when patients with squamous cell carcinoma are treated with surgery, as opposed to radiation, in addition to adjuvant treatment, Dr. Farsad told Medscape.

"We also wanted to see how age and gender affect the outcome," he added. "We found that these 'modifiers' greatly affected the outcome. Age in particular seemed to have a significant effect on the outcome, in that the advantage of surgery over radiation was greatest in the youngest age group," Dr. Farsad said.

"Our results showed that, overall, patients undergoing radiation plus adjuvant therapy are 2.61 times more likely to die than patients undergoing surgery plus adjuvant treatment," Dr. Farsad said. "Moreover, this effect was much greater in the younger patients, particularly those who were less than 30 years old at the time of diagnosis, and these differences were even more pronounced in women then men," he added. "So what we've learned from this study is that if you see squamous cell carcinoma in younger patients, don't take chances, do the surgery."

One weakness of the study, according to Robert Lovinger, MD, FAAP, was that the researchers did not take into account the stage or size of the carcinoma, which may have influenced the type of treatment given, in addition to the training and/or personal preference of the physician involved. Dr. Lovinger is research and program development director of the Preventive Medicine Residency Program at the Palm Beach County Health Department in Florida. He was not involved in the study.

In an interview with Medscape, Dr. Lovinger emphasized that despite this study limitation, "this is an important study, and its outcome suggests that surgery, as opposed to radiation, should be the treatment of choice for patients with squamous cell carcinoma, especially those in the younger age groups."

ACPM 2007 Annual Meeting: Poster 13. Presented February 22, 2007.

 
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