Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The oral cavity
- Nancy Y Lee, MD
Nancy Y Lee, MD
- Attending Physician
- Memorial Sloan-Kettering Cancer Center
- Neil D Gross, MD, FACS
Neil D Gross, MD, FACS
- Associate Professor
- Director of Clinical Research
- Head and Neck Surgery
- MD Anderson Cancer Center
- Scott Okuno, MD
Scott Okuno, MD
- Professor of Oncology
- Division of Medical Oncology
- Mayo Clinic
- Shyam SD Rao, MD, PhD
Shyam SD Rao, MD, PhD
- Assistant Professor of Radiation Oncology
- University of California Davis Comprehensive Cancer Center
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
The treatment of locoregionally advanced (stage III and IV (table 1)) squamous cell carcinoma of the oral cavity is discussed here.
An overview of the approach to oral cavity cancer and the treatment of early stage disease are presented separately, as is the management of patients with metastatic and recurrent disease:
ANATOMY AND STAGING
The oral cavity extends from the skin-vermilion junction of the lips to the junction of the hard and soft palate above and to the line of circumvallate papilla of the tongue below (figure 1). The anterior tonsillar pillars and glossotonsillar folds serve as the lateral boundaries between the oral cavity and oropharynx.
- Ridge JA, Lydiatt WM, Patel SG, et al. Lip and Oral Cavity. In: AJCC Cancer Staging Manual, 8th, Amin MB. (Ed), Springer, New York 2017. p.79.
- Oliver RJ, Clarkson JE, Conway DI, et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2007; :CD006205.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Robertson AG, Soutar DS, Paul J, et al. Early closure of a randomized trial: surgery and postoperative radiotherapy versus radiotherapy in the management of intra-oral tumours. Clin Oncol (R Coll Radiol) 1998; 10:155.
- Iyer NG, Tan DS, Tan VK, et al. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer 2015; 121:1599.
- Liao CT, Chang JT, Wang HM, et al. Analysis of risk factors of predictive local tumor control in oral cavity cancer. Ann Surg Oncol 2008; 15:915.
- Laskar SG, Chaukar D, Deshpande M, et al. Phase III randomized trial of surgery followed by conventional radiotherapy (5 fr/Wk) (Arm A) vs concurrent chemoradiotherapy (Arm B) vs accelerated radiotherapy (6fr/Wk) (Arm C) in locally advanced, stage III and IV, resectable, squamous cell carcinoma of oral cavity- oral cavity adjuvant therapy (OCAT): Final results (NCT00193843). J Clin Oncol 34, 2016 (suppl; abstr 6004).
- Ghosh-Lasker S, Chauker D, Deshpande M et al. Phase III randomized trial of surgery followed by conventional radiotherapy (5 fr/Wk) (Arm A) vs concurrent chemoradiotherapy (Arm B) vs accelerated radiotherapy (6fr/Wk) (Arm C) in locally advanced, stage III and IV, resectable, squamous cell carcinoma of oral cavity- oral cavity adjuvant therapy (OCAT): Final results (NCT00193843). J Clin Oncol 2016; 34 (suppl; abstr 6004).
- Licitra L, Grandi C, Guzzo M, et al. Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial. J Clin Oncol 2003; 21:327.
- Bossi P, Lo Vullo S, Guzzo M, et al. Preoperative chemotherapy in advanced resectable OCSCC: long-term results of a randomized phase III trial. Ann Oncol 2014; 25:462.
- Zhong LP, Zhang CP, Ren GX, et al. Randomized phase III trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma. J Clin Oncol 2013; 31:744.
- Turner SL, Slevin NJ, Gupta NK, Swindell R. Radical external beam radiotherapy for 333 squamous carcinomas of the oral cavity--evaluation of late morbidity and a watch policy for the clinically negative neck. Radiother Oncol 1996; 41:21.
- Stenson KM, Kunnavakkam R, Cohen EE, et al. Chemoradiation for patients with advanced oral cavity cancer. Laryngoscope 2010; 120:93.
- Salgarelli AC, Sartorelli F, Cangiano A, et al. Surgical treatment of lip cancer: our experience with 106 cases. J Oral Maxillofac Surg 2009; 67:840.
- Gooris PJ, Maat B, Vermey A, et al. Radiotherapy for cancer of the lip. A long-term evaluation of 85 treated cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86:325.
- Guinot JL, Arribas L, Chust ML, et al. Lip cancer treatment with high dose rate brachytherapy. Radiother Oncol 2003; 69:113.
- Rodgers LW Jr, Stringer SP, Mendenhall WM, et al. Management of squamous cell carcinoma of the floor of mouth. Head Neck 1993; 15:16.
- Nason RW, Sako K, Beecroft WA, et al. Surgical management of squamous cell carcinoma of the floor of the mouth. Am J Surg 1989; 158:292.
- Zelefsky MJ, Harrison LB, Fass DE, et al. Postoperative radiotherapy for oral cavity cancers: impact of anatomic subsite on treatment outcome. Head Neck 1990; 12:470.
- Bell RB, Kademani D, Homer L, et al. Tongue cancer: Is there a difference in survival compared with other subsites in the oral cavity? J Oral Maxillofac Surg 2007; 65:229.
- Sessions DG, Spector GJ, Lenox J, et al. Analysis of treatment results for oral tongue cancer. Laryngoscope 2002; 112:616.
- Fein DA, Mendenhall WM, Parsons JT, et al. Carcinoma of the oral tongue: a comparison of results and complications of treatment with radiotherapy and/or surgery. Head Neck 1994; 16:358.
- Mendenhall WM, Morris CG, Amdur RJ, et al. Retromolar trigone squamous cell carcinoma treated with radiotherapy alone or combined with surgery. Cancer 2005; 103:2320.
- Huang CJ, Chao KS, Tsai J, et al. Cancer of retromolar trigone: long-term radiation therapy outcome. Head Neck 2001; 23:758.
- Yorozu A, Sykes AJ, Slevin NJ. Carcinoma of the hard palate treated with radiotherapy: a retrospective review of 31 cases. Oral Oncol 2001; 37:493.
- Diaz EM Jr, Holsinger FC, Zuniga ER, et al. Squamous cell carcinoma of the buccal mucosa: one institution's experience with 119 previously untreated patients. Head Neck 2003; 25:267.
- Andersen PE, Warren F, Spiro J, et al. Results of selective neck dissection in management of the node-positive neck. Arch Otolaryngol Head Neck Surg 2002; 128:1180.
- Byers RM, Weber RS, Andrews T, et al. Frequency and therapeutic implications of "skip metastases" in the neck from squamous carcinoma of the oral tongue. Head Neck 1997; 19:14.
- Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006; 134:460.
- Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 2009; 47:5.
- De Cicco C, Trifirò G, Calabrese L, et al. Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept. Eur J Nucl Med Mol Imaging 2006; 33:900.
- Capote-Moreno A, Naval L, Muñoz-Guerra MF, et al. Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma. J Oral Maxillofac Surg 2010; 68:268.
- Frank DK, Sessions RB. Management of the neck: Surgery. In: Head and Neck Cancer: A Multidisciplinary Approach, 3rd, Harrison LB, Sessions RB, Hong WK (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2009. p.181.
- Koch, WM, Stafford, et al. Cancer of the oral cavity.. In: Head and neck cancer: a multidisciplinary approach., 3rd ed, Harrison, LB, Sessions, RB, Hong, WK (Eds), Lippincott Williams & Wilkins, Philadelphia 2009. p.250.
- Gomez DR, Zhung JE, Gomez J, et al. Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers. Int J Radiat Oncol Biol Phys 2009; 73:1096.
- Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg 1998; 118:616.
- Oh HK, Chambers MS, Martin JW, et al. Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 2009; 67:1378.
- Curtis DA, Plesh O, Miller AJ, et al. A comparison of masticatory function in patients with or without reconstruction of the mandible. Head Neck 1997; 19:287.
- Urken ML, Buchbinder D, Weinberg H, et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 1991; 101:935.
- http://seer.cancer.gov/csr/1975_2007/ (Accessed on March 14, 2011).
- Liao CT, Chang JT, Wang HM, et al. Survival in squamous cell carcinoma of the oral cavity: differences between pT4 N0 and other stage IVA categories. Cancer 2007; 110:564.
- Shah JP, Cendon RA, Farr HW, Strong EW. Carcinoma of the oral cavity. factors affecting treatment failure at the primary site and neck. Am J Surg 1976; 132:504.
- Gil Z, Carlson DL, Boyle JO, et al. Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer 2009; 115:5700.
- Gross ND, Patel SG, Carvalho AL, et al. Nomogram for deciding adjuvant treatment after surgery for oral cavity squamous cell carcinoma. Head Neck 2008; 30:1352.
- Myers JN, Greenberg JS, Mo V, Roberts D. Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 2001; 92:3030.
- Fagan JJ, Collins B, Barnes L, et al. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 1998; 124:637.
- Arduino PG, Carrozzo M, Chiecchio A, et al. Clinical and histopathologic independent prognostic factors in oral squamous cell carcinoma: a retrospective study of 334 cases. J Oral Maxillofac Surg 2008; 66:1570.
- ANATOMY AND STAGING
- General principles
- Pretreatment evaluation
- Treatment of primary tumor
- - Surgical technique
- - Postoperative RT and chemoradiotherapy
- - Induction radiation therapy and/or chemotherapy
- - Nonsurgical candidates
- Oral cavity subsites
- - Lip
- - Floor of mouth
- - Oral tongue
- - Lower alveolar ridge and retromolar trigone
- - Upper alveolar ridge and hard palate
- - Buccal mucosa
- Supportive care measures
- MANAGEMENT OF THE NECK
- POSTTREATMENT EVALUATION AND SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS