Barium paste: useful for primary tumour localization in oral cancer.

Abstract

The role of external beam radiotherapy (RT) in the management of squamous cell carcinoma (SCC) of the oral cavity is well established. The local control for early tumours (T1 and T2 lesions), when managed with RT is comparable with surgery although a direct comparison in a randomized setting is lacking. Multimodality treatment using surgical resection, RT and chemotherapy are usually required for more advanced lesions. However, with recent refinement and advancement in reconstructive techniques, surgery has gained popularity in many centres, as functional impairment from modern free flap techniques is considerably less than older surgical techniques. Nevertheless, for small volume oral cavity tumours, radiotherapy still offers excellent local control and functional results. Some patients are often too frail or unwilling to undergo radical surgery. Therefore, radiotherapy remains an effective alternative to surgery. One of the potential disadvantages of RT for oral cavity cancer is osteoradionecrosis (ORN) of the mandible. This late effect of RT may contribute to continuing morbidity in patients that are otherwise cured of their cancers and should be prevented where possible. Numerous clinical and physical factors have been reported [1] to be associated with ORN; these factors are summarized in Table 1. However, the underlying cause of ORN is often speculative as most studies are retrospective and heterogeneous. The effect of radiotherapy field size or irradiated volume, as a treatment-related factor for ORN is not comprehensively established in the literature. We previously reported the relationship between normal tissue late effects and RT treatment volume in a cohort of 333 patients with SCC of the oral cavity treated with radical radiotherapy [2]. There was no grade 3 or 4 late morbidity seen at radiation doses of 50 Gy and 52.5 Gy in 3 weeks for volumes less than 700 cm 3 and 300 cm 3 , respectively.