Abstract
Objective: 1) Become aware of the role of intraoperative fluorescence visualization in assessing subclinical changes at surgical margins in patients presenting with severe dysplasia and carcinoma in situ (HGD) or squamous cell carcinoma (SCC). 2) Understand the effectiveness of FV-guided surgery in reducing locoregional recurrence and improving overall survival.
Method: A retrospective review was conducted from September 1, 2004, to August 31, 2009, identifying 246 patients (SCC 132; HGD 114) presenting to the BCCA. Surgery was done under FV guidance in 149 patients while 97 were treated conventionally. Outcome measures included pathology-proven local recurrence, regional failure, and death.
Results: There was no significant difference between FV and control groups in age, smoking habit, lesion anatomic site, diagnosis, tumor size, and previous cancer history. There were more females in the FV group (51% vs 33%, P = .006). Time to outcome curve was estimated by the Kaplan-Meier method. With an average of 40 months follow-up, the FV group shows significantly lower local recurrence (7% vs 38%), regional failure (6% vs 23%), and death (5% vs 20%), and significant longer time to recurrence (P < .0001), regional failure (P = .0007), and death of disease (P = .004).
Conclusion: The data strongly suggest that use of FV for surgical margin guidance can significantly improve outcomes in early stage oral cancer and HGD. An ongoing 5-year multicenter phase III randomized surgical trial (COOLS), funded by Terry FoResearch Institute, has been established to validate the results of this study.
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