Radiation and Chemotherapy in Oral and Maxillofacial Surgery

Abstract

Oral cavity cancer is the sixth most prevalent cancer worldwide(1]and comprise about 85% of all head and neck cancers. Regions with a high incidence of oral cancer ( > 6.9/100,000] are : North America, Brazil, Europe, South Africa, the Indian Subcontinent, and Australia Areas with low incidence (< 3.2/100.000] are Central America, Chile, West Africa, Middle East and China. [2]The higher incidence of oral cancer in high income countries, and increasingly in mid‐ dle-income countries, is thought to be due to tobacco usage, unhealthy diets, alcohol consump‐ tion, inactive lifestyles and infection. The use of tobacco, including smokeless tobacco, and excessive consumption of alcohol are regarded as the major risk factors for oral cancer. [1]Al‐ though oral cancer originates from different types of tissues that are present in the mouth, around 85 90% are squamous cell carcinomas originating in the oral epithelium.The treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radia‐ tion oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilita‐ tion and restorative specialists. Curative treatment modalities are usually surgery and radiation, with chemotherapy added to sensitize the malignant cells to radiation, to decrease the possibility of metastasis, or as curative treatment for those patients who have confirmed dis‐ tant metastasis. The factors that influence the choice of treatment modality are related to the tu‐ mor and the desires of the patient. Primary site, size of the tumor, lymph node involvement and the presence or absence of distant metastasis are factors which will affect a particular treatment option. Surgery is the most common treatment for mouth cancer, while oropharyngial cancer is usually treated with radiation, with or without chemotherapy. Most oncologist consider radio‐ therapy or chemoradiotherapy (CRT) as first-line therapy in oropharynx cancer due to the equivalent response rates compared with surgery. Salivary gland tumors are commonly treated with surgery initially. In general, Stage I and Stage II oral cancers may be treated successfully with either surgery or radiation therapy. Advanced Stage III and Stage IV cancers are typically treated by surgical resection followed by radiotherapy (RT) or CRT