Advanced Oral Cancer Research Articles

Transformative Potential of Artificial Intelligence in Enhancing Oral and Maxillofacial Cancer Care for a Brighter Tomorrow

The integration of Artificial Intelligence (AI) has significantly advanced oral and maxillofacial cancer (OMC) care. This paper explores the transformative potential of AI in OMC diagnosis, staging, treatment, and prognosis. AI-driven applications, including computervision and machine learning, are discussed, emphasizing their impact on early detection,accurate diagnosis, and personalized treatment planning. The paper also explores the role of AI in OMC education, research, and practice, outlining future directions. In OMC staging, AI automates the process by analyzing medical records and imaging data, enhancing accuracy. The paper also discusses AI's role in tailoring treatment plans, optimizing radiation therapy, and facilitating robotic surgery. Furthermore, the integration of ChatGPT in OMC education, research, and practice is explored. The paper outlines future directions, including the integration of multi-omics data and real-time patient monitoring, emphasizing collaboration, clinical trials, and validation as essential steps in realizing AI's potential in routine clinical practice. In conclusion, AI has the potential to transform OMC management by enhancing diagnosis accuracy, staging precision, personalized treatment planning, and prognosis estimation. Addressing ethical concerns and fostering interdisciplinary collaboration are crucial in harnessing AI's capabilities. By embracing AI advancements, OMC care can be significantly improved, leading to better patient outcomes and contributing to the fight against oral and maxillofacial cancer.

Utility of lymphocyte-to-monocyte ratio and pretreatment tooth extraction in intra-arterial chemoradiotherapy for oral cancer to prevent osteoradionecrosis of the jaw

The objective of this study was to evaluate the utility of inflammation-based prognostic scores (IBPS) in predicting ORN among patients undergoing superselective intra-arterial chemoradiotherapy (SSIACRT). This retrospective cohort study examined the medical records of 54 patients with advanced oral cancer (stage 3 or 4) treated with SSIACRT. The predictor variable was IBPS. The main outcome variable was onset of ORN. Covariates comprised sex, median age, tooth status, tumor size, and pretreatment tooth extraction with professional oral care (pretreatment tooth extraction). For each factor, cumulative incidence and univariate and multivariate analyses of ORN incidence were performed. The cumulative incidence of ORN in patients with pre-treatment lymphocyte-to-monocyte ratio (LMR < 4.95vs LMR ≥4.95, P = 0.01) and pretreatment tooth extraction (no vs. yes, P = 0.03) was significantly different. Univariate and multivariate analyses identified pre-treatment LMR cutoff values < 4.95 and pre-treatment tooth extraction as significantly associated with the development of ORN. Pretreatment tooth extraction reduced the incidence of ORN in low LMR group (P = 0.04). LMR is a useful biomarker to predict ORN in SSIACRT. Pretreatment tooth extraction was a useful treatment to prevent ORN. Pretreatment extraction with LMR may be important for the prevention of ORN in SSIACRT.

Advancements in Immunotherapy for Oral Cancer Research

Oral cancer is one of the common malignant tumors of the head and neck. The survival rate in the late stage is about 50%. At present, more and more immunotherapy is gradually used in the clinical treatment of oral cancer. Some relevant experiments on the efficacy of immunotherapy for the treatment of oral cancer are also actively carried out. However, at present, there is a lack of the latest experimental data on the review of immunotherapy for oral cancer, and the classification method is quite single. This paper divides oral cancer into three stages: prevention, early and late stages, and comprehensively evaluates and analyzes the application effects of immunotherapy at each stage. In particular, based on the KEYNOTE-048 trial data in February 2023, it elaborates on the therapeutic effect of Pembrolizumab in patients with advanced oral cancer. Although there are many types of immunotherapy, some are still only in the theoretical stage and have limited clinical data in oral cancer. At the same time, the treatment boundaries for different stages are still unclear, and clinical applications mainly depend on the patient's immune status and condition. This review aims to provide more valuable reference for further research.

Efficacy of Paclitaxel and Cetuximab in Recurrent/Metastatic Oral Cancer Cases Following Superselective Intraarterial Chemoradiotherapy: A Retrospective Cohort Study.

The therapeutic efficacy of the paclitaxel (PTX) + cetuximab (Cmab) combination regimen was investigated in patients with recurrence or metastasis after superselective intraarterial chemoradiotherapy (SSIACRT) for oral cancer, and the safety was retrospectively examined. All enrolled patients with advanced oral cancer or who had refused surgery over 10 years from December 2012 to December 2022 underwent SSIACRT for 6 to 9 weeks [cisplatin (CDDP): total 160-630 mg/m2and radiotherapy: total 50-70 Gy]. Nine cases (tongue cancer, maxillary gingival cancer, and mandibular gingival cancer; three cases each) were subjected to PTX + Cmab therapy. Recurrence or metastases were observed within six months after the onset of treatment, complicating the conduct of salvage surgery. Cmab (first dose: 400 mg/m2and second and following doses: 250 mg/m2) and PTX (80 mg/m2) were administered weekly. The overall response rate was 44.4% (four of nine cases), and the disease control rate was 88.9% (eight of nine cases), whereas the median progression-free survival was seven months, and the overall survival was 11 months. Grade 3-4 adverse events were neutropenia in 33.3% of the cases, leukopenia in 55.6%, anemia in 22.2%, and acneiform skin rash in 22.2%. Based on the above, PTX + Cmab therapy for recurrent and metastatic cases after SSIACRT had comparable results to other second-line modalities and enabled to cope with the side effects of myelosuppression. PTX + Cmab therapy may be an effective treatment mode for recurrent or metastatic head and neck cancer resistant to CDDP after SSIACRT treatment.

Outcomes of Neoadjuvant Chemotherapy in Locally Advanced Oral Cancers: A Retrospective Analytical Study.

Introduction Head and neck cancers account for 30% of malignancies in India and oral squamous cell carcinoma is most common. 80% of the patients present with locally advanced disease and many of them are inoperable. In this study we documented the outcomes of neoadjuvant chemotherapy (NACT) in locally advanced oral cancer staged T4 with regards to downstaging the disease and to make the tumor more amenable for surgery with better access. The objectives of the study are to document the outcomes of NACT in patients with locally advanced oral cancers and to correlate the response to NACT and adequacy of resection by histopathology examination of the specimen. Methodology Clinical data of 96 patients with locally advanced squamous cell carcinoma of the oral cavity staged T4a and T4bwho received two cycles of NACT between December 2018 and November 2022 were reviewed respectively and the outcomes and response following NACT were documented. Results Among 96 patients in this study, 68 (70.9%) patients were staged T4a and 28 (29.1%) were staged T4b. 31 (30.2%) patients showed partial response, 36 (37.5%) had stable disease and 29 (30.2%) had progressive disease following 2 cycles of NACT. All patients underwent definitive surgery following NACT and were followed up for 14 months. Among those staged T4a, 12 patients (33.3%)had close margins, eight patients (34.8%) had positive margins and 10 patients (16.2%) had a recurrence. Among those staged T4b, 24 patients (66.7%) had close margins (less than 5mm distance after formalin fixation), 15 patients (65.2%) had positive margins while 17 patients (60.7%) had a recurrence in the 14 month follow-up period. Conclusion NACT makes tumors more amenable for surgery in locally advanced oral squamous carcinoma. However, 30% of patients do not respond to it.

Thoracoabdominal Flap Closure for Large Post Pectoralis Major Myocutaneous Flap Donor Site in Advanced Oral Cancer: An Innovative Approach in Resource Constraint Setting.

Oral cancer often presents in advanced stages, requiring complex surgical interventions. The bipedal pectoralis major myocutaneous (PMMC) flap is a commonly used alternative to the gold standard free flaps for reconstruction in resource-constrained settings. However, large donor sites may necessitate split-thickness skin grafting (STSG), leading to aesthetic challenges. This study explores using the thoracoabdominal flap (TA) for a large donor site closure following PMMC flap harvest in advanced oral cancer reconstruction. A retrospective analysis was conducted on twelve patients with advanced oral cancer with extensive skin involvement. The TA flap was utilised to achieve tension-free closure of the donor site. Patient demographics, clinical features, treatment stage, operative details, and postoperative complications were meticulously recorded. All patients had advanced oral cancer, with seven having left-sided disease and five having right-sided disease. The TA flap closure resulted in minimal complications, with two patients developing seromas and one experiencing marginal necrosis during the postoperative period. The innovative TA flap technique is useful in closing extensive donor sites following PMMC flap harvest for advanced oral cancer cases. It offers advantages such as improved cosmetic outcomes and fewer complications than split-thickness skin grafting.

RRx-001 Affects Multiple Toxicities in Patients Receiving Concomitant Chemoradiation for Head and Neck Cancers: Observations of the PREVLAR Phase II Trial

PURPOSE Phase IIa trial results suggested that RRx-001, an nucleotide-binding domain-like receptor protein 3 inhibitor and nuclear factor erythroid 2–related factor 2 activator, attenuated severe oral mucositis (SOM) in patients treated with concomitant chemoradiation (CRT) for oral cancer (OC) and oropharyngeal cancer (OPC). Given the shared pathobiology of CRT injury among other exposed tissues, we initiated a secondary analysis of reported adverse events (AEs) to assess RRx-001's potential benefit on non-SOM regimen-related toxicities. METHODS PREVLAR was an open-label randomized trial that has been completed and published. Patients were treated with CRT for locally advanced OC or OPC. Arms 1-3 received doses of RRx-001 twice a week beginning 2 weeks before the start of CRT. Arm 2 (n = 11) received additional RRx-001 once during weeks 2 and 5. Arm 3 (n = 13) received RRx-001 once a week for the first 6 weeks of CRT. Arm 4 (n = 10) received CRT only. Patients received standard intensity modulated radiation therapy (daily fractions of 2-2.2 Gy/minimum cumulative dose of 55 Gy) plus cisplatin. Comprehensive toxicity assessment was based on reported AEs graded using Common Terminology Criteria for Adverse Events v5.0 and categorized with the Medical Dictionary for Regulatory Activities. A two-sided Fisher's exact test was performed to compare AE incidences between RRx-001 arms and standard of care in a secondary analysis of the data. Overall false-positive rate in Fisher's exact test was controlled via Hochberg's adjustment method. RESULTS Compared with the control cohort, patients receiving RRx-001 demonstrated fewer AEs attributable to their CRT regimen. Statistically significant differences in AE incidences favoring RRx-001 were dependent on the RRx-001 dosing regimen. CONCLUSION This secondary analysis suggests that RRx-001 infusion may reduce multiple, biologically related AEs associated with a standard CRT regimen. More broadly, it suggests that it is possible that agents that effectively target central pathobiology targets may mitigate more than one toxicity.

Use of Pectoralis Major Myocutaneous Flap for Marginal Mandibulectomy Defects of Oral Cavity Cancers - A 5 Year Institutional Experience.

Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenović A, Virag M, Uglešić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340-343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251-254); (Porcuna DV, Vintró XL, Vilas ML, Olmo AP, Ayala JM, Agustí MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263-268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published.

Efficacy of tracheostomy for respiratory management in patients with advanced oral cancer

BackgroundMany studies have been reported on tracheostomy to prevent upper airway obstruction after surgery. Among these, the scoring system proposed by Cameron et al. quantifies various factors that influence postoperative respiratory failure. This system provides a basis for surgeons to decide whether to perform an elective tracheostomy. In this study, the authors applied the Cameron scoring system retrospectively to patients undergoing severe oral cancer surgery to reevaluate the indications for elective tracheostomy and to investigate its clinical efficacy in airway management. In this study, a sample of 20 patients who underwent oral cancer surgery was selected and divided into two groups: 10 underwent tracheostomy and 10 did not. The Cameron scoring scores for each patient were extracted, to verify whether elective tracheostomy was performed in accordance with the threshold scores. Differences in scores and significant clinical impact factors between the two groups were analyzed and compared.ResultThe 10 patients who underwent tracheostomy had an average Cameron score of 6.4, all scoring above the recommended threshold of 5 for tracheostomy. For the 10 patients who did not undergo tracheostomy, the average score was 2.5, with 8 out of these 10 patients scoring below 5. Significant clinical impact factors observed included the location and size of the tumor, the performance of mandibulectomy and neck dissection, and the type of reconstruction surgery.ConclusionIn planning surgery for oral cancer patients, it is essential to consider the use of elective tracheostomy based on preoperative assessment of the risk of postoperative airway obstruction using tools like the Cameron scoring system, and patients’ condition. Research confirms that elective tracheostomy effectively enhances airway management in patients with severe oral cancer.

Circulating T cell status and molecular imaging may predict clinical benefit of neoadjuvant PD-1 blockade in oral cancer

BackgroundAddition of neoadjuvant immune checkpoint inhibition to standard-of-care interventions for locally advanced oral cancer could improve clinical outcome.MethodsIn this study, 16 evaluable patients with stage III/IV oral cancer were treated...

Intra-arterial chemoradiotherapy for oral cancer: Superiority of intensity-modulated radiation therapy over three-dimensional conformal radiation therapy

PurposeTo determine the superiority of intensity-modulated radiation therapy (IMRT) over three-dimensional conformal radiation therapy (3DCRT) in patients who underwent intra-arterial chemoradiotherapy for oral cancer. MethodsWe retrospectively analyzed patients with locally advanced oral cancer curatively treated with intra-arterial chemoradiotherapy at a single institution between 2010 and 2021. All patients treated after May 2015 underwent IMRT. Docetaxel (12 mg/m2/week) and nedaplatin (5 mg/m2/day) were administered through a shallow temporal artery using a catheter. ResultsIn total, 143 patients (IMRT: 71; 3DCRT: 72) were included in this study. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 75.7 % and 59.8 %, respectively, with no significant differences between the irradiation methods. In multivariate analysis, cervical lymph node metastasis (LNM) was the only significant poor prognostic factor contributing to OS, PFS, locoregional control (LRC), and local control (LC). In multivariate subgroup analysis of LNM cases (n = 90), IMRT contributed to favorable LRC (hazard ratio [HR]=0.4, P = 0.01) and LC (HR=0.4, P = 0.006). There was no difference in the incidence of grade ≥2 osteonecrosis of the jaw (4.2 % vs. 12.5 %, P = 0.13), xerostomia (75 % vs. 82 %, P = 0.316), or dysgeusia (80 % vs. 82 %, P = 0.834) between the IMRT and 3DCRT groups. However, the rates of xerostomia at 6 months and dysgeusia at 3 months were lower in the IMRT group (both P < 0.001). ConclusionIMRT neither improved patient survival nor significantly reduced the incidence of osteonecrosis of the jaw. However, it demonstrated favorable LRC and LC in patients with LNM, suggesting an advantage in early recovery from xerostomia and dysgeusia.

Long-term outcomes in virtual surgical planning for mandibular reconstruction: A cost-effectiveness analysis.

This study is an economic evaluation comparing virtual surgical planning (VSP) utilization to free hand mandibular reconstruction (FHR) for advanced oral cavity cancer, for which the cost effectiveness remains poorly understood. The proposed clinical benefits of VSP must be weighed against the additional upfront costs. A Markov decision analysis model was created for VSP and FHR based on literature review and institutional data over a 35-year time horizon. Model parameters were derived and averaged from systematic review and institutional experience. VSP cost and surgical time saving was incorporated. We accounted for long-term risks including cancer recurrence and hardware failure/exposure. We calculated cost in US dollars and effectiveness in quality-adjusted-life-years (QALYs). A health care perspective was adopted, discounting costs and effectiveness at 3%/year. Deterministic and probabilistic sensitivity analyses tested model robustness. In the base case scenario, total VSP strategy cost was $49,498 with 8.37 QALYs gained while FHR cost was $42,478 with 8.27 QALY gained. An incremental cost-effectiveness ratio (ICER), or the difference in cost/difference in effectiveness, for VSP was calculated at $68,382/QALY gained. VSP strategy favorability was sensitive to variations of patient age at diagnosis and institutional VSP cost with one-way sensitivity analysis. VSP was less economically favorable for patients >75.5 years of age or for institutional VSP costs >$10,745. In a probabilistic sensitivity analysis, 55% of iterations demonstrated an ICER value below a $100,000/QALY threshold. VSP is economically favorable compared to FHR in patients requiring mandibular reconstruction for advanced oral cancer, but these results are sensitive to the patient's age at diagnosis and the institutional VSP cost. Our results do not suggest if one "should or should not" use VSP, rather, emphasizes the need for patient selection regarding which patients would most benefit from VSP when evaluating quality of life and long-term complications. Further studies are necessary to demonstrate improved long-term risk for hardware failure/exposure in VSP compared to FHR.

Can Prophylactic Tracheostomy be Avoided in Advanced Oral Cancer Surgery for Airway Management? An Experience and Guidelines from a Tertiary Care Facility.

To evaluate the surgical and postoperative management strategies that contribute to minimizing the need for prophylactic tracheostomy for airway management in advanced oral cancer surgery. A retrospective review of the patients who underwent surgery for advanced oral cancer, in our institution from February 2015 to January 2024. In the present review, 66 patients (males, n = 54; females, n = 12; mean age 50.3years) who were operated for advanced oral cancer (T3, T4 oral squamous cell carcinoma and osteosarcoma of the mandible requiring mandibular resection) in our institution were included. 60 patients (90.9%) had reconstruction after segmental resection of the mandible without the need for prophylactic tracheostomy. Out of these, eighteen patients (27.27%) required segmental resection of the mandible crossing midline. Six patients (9.1%) underwent prophylactic tracheostomy, of which two patients had unilateral tumor and four patients had tumor crossing midline. Comparison of hospital stays between patients who underwent prophylactic tracheostomy and those who did not yielded mean durations of 13.3days and 7.6days, respectively. Except a subset of patients with old age, obesity, bulky neck, and those with respiratory compromise, following the present guidelines, prophylactic tracheostomy can be avoided in patients undergoing surgery for advanced oral cancer.

Precision Medicine and Clinical Trials in Advanced and Metastatic Oral Cancer.

Oral cancer is a significant global health concern, with high morbidity and mortality rates, particularly in regions with prevalent tobacco usage such as Asia. Majority of oral cancers are detected at an advanced stage resulting in poor survival outcomes. Moreover, the treatment modalities of oral cancers have remained constant with surgery and concurrent chemoradiotherapy being mainstays of the treatment. This review provides a significant progress made in understanding the molecular landscape of oral cancers and the evolution of therapeutic strategies toward precision medicine. A comprehensive literature review was conducted to gather recent studies on the molecular landscape of oral cancers, genomic insights, and clinical trials. Firstly, genomic insights into oral cancers, including key driver mutations and copy number alterations, are discussed in the context of personalized medicine approaches. Subsequently, advancements in therapeutic strategies, particularly focusing on clinical trials investigating immunotherapy and targeted agents, are highlighted. Despite promising results, challenges persist in identifying reliable biomarkers for treatment response and resistance. Continued research efforts are warranted to validate biomarkers and optimize therapeutic interventions, with the goal of enhancing patient outcomes and reducing the global burden of oral cancer.

"Clinical Outcomes of Surgically Treated Locally Advanced Oral Cavity Squamous Cell Carcinoma with Infra-Temporal Fossa Involvement: A Tertiary Cancer Centre Experience".

Traditionally, patients with T4b oral cavity cancer have been deemed inoperable, leading to palliative treatments, primarily radiation and chemotherapy. In this study, we aim to critically evaluate the outcome of surgical intervention, specifically Infra-temporal fossa (ITF) clearance, about disease-free survival and overall survival rates. This is a retrospective observational study conducted over 2years. 45 patients with clinical-radiological diagnosis of T4b disease, who had been subjected to surgery with ITF clearance were followed up for 2years to check for recurrence and mortality. Locoregional recurrence was observed in 20 patients (44.4%) among which 3 patients additionally had distant metastasis. At the last follow-up, the overall mortality noted was 26.7%, with 33 patients still alive, out of which 25 were disease-free. No significant correlation was found between patient or tumor-related factors and recurrence rates except positive soft tissue and close bone margins. Survival analysis revealed a mean disease-free survival (DFS) of 18.57months and an overall survival (OS) of 21.75months. Surgical resection is a viable option for a few selected patients with locally advanced oral cavity cancer, with acceptable outcomes.

Evaluating the Efficacy of Adjuvant Radiotherapy in the Management of Advanced Oral Cancer Cases.

Because of its high rates of morbidity and death, especially in its late stages, oral cancer poses a serious threat to world health. Even with improvements in surgical and chemotherapeutic techniques, advanced oral cancer is still difficult to treat and frequently has unfavorable results. Information on demographics, tumor features, treatment options, and results were gathered from medical records. Patients were categorized according to whether they underwent surgery alone or adjuvant radiation treatment after initial surgical resection. For the survival analysis, Kaplan-Meier curves and Cox proportional hazards models were employed. There were 150 patients in all, 75 in each group, who took part in the trial. Comparing adjuvant radiation to surgery alone resulted in considerably better overall survival (P < 0.001) and disease-free survival (P < 0.001). However, problems connected to the adjuvant radiation group affected a portion of the patient population. In conclusion, patients with advanced oral cancer can improve their overall and disease-free survival with adjuvant radiation, a successful therapeutic option. To maximize results, nevertheless, cautious patient selection and effective management of treatment-related problems are crucial. To improve treatment algorithms and investigate cutting-edge therapeutic techniques for this difficult condition, further research is necessary.

Associations of ctDNA clearance and pathological response after neoadjuvant treatment in patients with locally advanced oral cancer.

6043 Background: Neoadjuvant treatment (NAT) has improved clinical outcomes in some patients with locally advanced oral squamous cell carcinoma (LAOSCC). Effective biomarkers assessing the treatment response is still lacking. Previous studies have posed the potential of circulating tumor DNA (ctDNA) in monitoring treatment response, but the underlying mechanisms behind non-shedding in tumors remain unclear. Methods: 29 LAOSCC patients received NAT followed by surgery were enrolled. Seven (24.1%), 9 (31%), and 13 (44.8%) patients received NAT of apatinib+camrelizumab, TPF chemoagents, and toripalimab+paclitaxel+cisplatin, respectively. Tumor tissues before NAT underwent whole exome sequencing and whole transcriptome resequencing. Blood samples at pre-NAT (T0), mid-NAT (T1), before surgery (T2) and after surgery (T3) were analyzed using a tumor-informed, personalized NGS assay. Multi-omics analysis, including ctDNA status, was performed with patients' clinical features and outcomes. Results: Among the 29 patients received NAT, the MPR rate was 55.2% (16/29), and the pCR rate was 27.6% (8/29). At baseline(T0), ctDNA was detectable in 25/29 (86.2%) patients, which decreased over time (T1: 77.8%; T2: 51.7%; T3: 6.9%). Persistent ctDNA at T2 indicates a higher rate of residual disease after NAT (100% non-pCR) compared to ctDNA-negative patients (42.8% non-pCR; p = 0.0047). All patients achieving pCR at T2 were ctDNA-negative (n=8, 100%) including 2 non-shedders. The PPV and NPV for predicting pCR by ctDNA clearance at T2 were 57.1% (8/14) and 100% (15/15), respectively. ARSF, CFAP47, or HAUS8 mutations at baseline were associated with significantly higher pCR rates (p&lt;0.05). Four non-shedders with undetectable ctDNA at T0 were significantly enriched in patients with negative lymph nodes, lower clinical T stage, and high CPS score. The non-shedders had significantly lower tumor mutational burden (TMB), higher stromal score and cancer-associated fibroblast (CAF) (p&lt;0.05). Spatial transcriptome analysis further supports that MHC-II pathway-related genes were significantly up-regulated in the non-shedders. The enhancing communication intensity between CAFs, endothelial cells and T cells might provide an anti-cancer immune microenvironment for non-shedders. Conclusions: Our results indicate that the clearance of ctDNA clearance at T2 was associated with an improved pCR rate. Furthermore, our findings shed light on the factors that prevent ctDNA release from oral squamous cell carcinoma.[Table: see text]

Dynamics of saliva cytokine levels during intraoperative photodynamic therapy in patients with locally advanced oral cancer

Dynamics of saliva cytokine levels during intraoperative photodynamic therapy in patients with locally advanced oral cancer

Quality-of-Life Outcomes in Oral Cancer Patients Reconstructed With Double Free Flaps: A Preoperative and Postoperative Assessment.

This study aimed to evaluate quality of life (QOL) in patients with locally advanced oral cancer who underwent surgical resection followed by simultaneous double free flap reconstruction. Institutional database was reviewed from 2015 to 2021 and prospectively collected University of Washington Quality of Life data that were extracted for patients who met the inclusion criteria. Mean, composite, and best percentage scores were computed. Wilcoxon signed rank test was used to analyze differences between groups. Thirteen patients completed the assessment, all of them being male with a mean follow-up of 2.2 ± 1.2 years. Most common double free flap combination was fibula osteoseptocutaneous flap and anterolateral thigh flap (n = 11). Improvement in pain ( P = 0.01) domain score with decline in speech ( P = 0.01) and taste ( P = 0.02) was noted along with an overall decline in QOL ( P = 0.001) after cancer diagnosis. A decrease in physical function was seen postoperatively. Chewing and saliva were the most cited postoperative patient-reported domain affecting QOL. In double free flap reconstructed patients, in the postoperative phase, pain scores improved, whereas speech and taste scores declined. The overall health-related QOL declined compared with before cancer diagnosis.

2228: Lymphovascular invasion as prognostic factor in locally advanced oral tongue cancer

2228: Lymphovascular invasion as prognostic factor in locally advanced oral tongue cancer