Tongue Carcinoma Research Articles

Vascular and Neural Invasion in Oral Squamous Cell Carcinoma: A Study in an Iranian Population.

Among various parameters used to predict the outcome of malignancy, nerve invasion has been widely considered as a sign of aggressive behavior in oral cancers. According to the importance of neural invasion in predicting the outcome of oral squamous cell carcinoma (OSCC), this study aimed to evaluate the prevalence of neural and vascular invasion in OSCC. In this descriptive, analytical, and cross-sectional study, paraffin-embedded tissues of 62 OSCC in the health center of surgery and pathology were evaluated (2013-2015). Patients' archives were evaluated and recorded in terms of their age and gender. Hematoxylin and eosin (H&E) slides were then examined by two oral pathologists and scrutinized for the presence of nerve involvement, tumor differentiation, vascular and lymph node invasion, and depth of invasion. Data were analyzed using SPSS version 23, t-test, and one-way ANOVA (P < 0.05). Of 62 tumors, 12 patients showed only nerve invasion, 17 cases had only vascular invasion, and seven patients had both neural and vascular invasion, simultaneously, known as a neurovascular invasion. Furthermore, there was no vascular and neural invasion in 26 cases. There was a statistically significant correlation between vascular and neural invasion and the tumor site (P = 0.045). The highest frequency of neural invasion, as well as vascular invasion, was related to tongue tumors. The relation between neural and vascular invasion in OSCC with tumor's location was statistically significant. Lip and tongue carcinoma had shown more neurovascular invasion without relation to gender, age, and cell differentiation.

Multiple Targeting of HSP Isoforms to Challenge Isoform Specificity and Compensatory Expression.

Heat shock proteins (HSPs) are molecular chaperones that assist in protein folding, trafficking, and metabolism. Intracellular chaperone functions of HSPs had been well-investigated, but extracellular and exosomal HSPs have been recently found. Exosomal HSPs are intercellularly transferred, while extracellular HSPs play cytokine-like roles called chaperokines. We have shown that exosomal HSPs play key roles in intercellular communication between tongue carcinoma and tumor-associated macrophages in the tumor microenvironment. Notably, HSP90 isoforms consist of HSP90alpha, HSP90beta, mitochondrial TRAP1, and GRP94 in the endoplasmic reticulum. Moreover, many pseudogenes of HSP90 can be transcribed into RNA. Besides, the function of HSP90 is defined by their cochaperones, such as CDC37 or AHA1. Therefore, isoform-specific small interfering RNA (siRNA) is necessary for precisely targeting each HSP90 isoform and cochaperone. Nevertheless, we often encountered compensatory expression of HSP90 isoforms in the knockdown studies. Here, we provide dual and triple knockdown methods to target multiple RNA for challenging isoform-specific roles and compensatory expression of intracellular, extracellular, and exosomal HSPs.

Intra-operative intaoral ultrasonograpy ensures free deep resection margins in carcinoma tongue: A pilot study.

Resection of primary in carcinoma tongue is challenging as the tumor often spreads submucosal and deep in muscles. There are various Intraoperative tools available to guide tumor resection margins. We studied the use of intraoperative ultrasound-guided resection for obtaining free deep resection margins in cases of oral carcinoma tongue. To assess the feasibility of resection of tongue tumor using intraoral ultrasound intraoperatively. 5 patients of oral tongue squamous cell carcinoma were included in this prospective pilot study. Intraoral ultrasound-guided resection of the primary tongue tumor was done. The surgeon moved the probe over the tumor and focussed on the point of maximum invasion by the tumor. A 26 G needle was passed in the tongue at a point that was 10 mm away from the deepest point of infiltration. It marked the deepest plane of resection. Following the above marking, a resection of tumor was done. Deep surgical resection margin was found to be >5 mm (free) in all the USG-guided surgically resected primary tongue tumors on histopathological examination. We have found intraoperative ultrasonography a useful tool for the surgical resection of primary tongue tumours.

Radiation induced osteosarcoma of clavicle: A case report

Radiation induced sarcomas (RIS) are the most dreaded long-term complications of head and neck irradiation. RISs are usually high grade and aggressive in nature. Although osteosarcoma is a common RIS in head and neck region, radiation induced osteosarcoma of the clavicle is rarely reported and generalized outcome is poor. Here we report a case of radiation induced osteosarcoma of the clavicle following neck irradiation for a carcinoma of tongue.

Pre-resection Intraoperative Core Biopsies in Oral Tongue Cancer-A Pilot Study.

To assess a novel intraoperative core biopsy technique to provide enhanced guidance in partial glossectomies. All patients diagnosed with squamous cell carcinoma of the oral tongue were eligible for study participation. Following anesthesia, the planned resection and three points midway between the gross tumor and the intended ablation were marked. A core biopsy was performed with a needle spring on each point and sent for frozen sections. The initially planned resection was executed if the cores returned free of tumor. In case of a positive core biopsy, a new 1-1.5 cm margin was marked around that point. The main outcome measure was the closest final margin diameter, especially the deep ones. Other outcome measures were the core biopsies' sensitivity, specificity, and negative predictive value. Complications were recorded. The final margins of 10 patients undergoing intraoperative core biopsies and 20 matched controls were analyzed. One patient had two positive cores and final negative margins after modifying the resection accordingly. Another patient had a positive biopsy diagnosed only on final pathology, and one close final margin. Patients that were operated with the new technique had larger margins compared to the controls: median (interquartile range) closest margin 5.95 (3.97; 9.63) mm versus 4 (2.25; 5) mm (p =0.074) and median deep margin 8.6 (6.16; 10) mm versus 5 (3;10) mm (p =0.411), respectively. There were no complications. A novel pre-resection intraoperative biopsy technique is presented. Core biopsies taken during glossectomies have the potential to prevent inadequate margins. 3 Laryngoscope, 133:2232-2236, 2023.

GENDER WISE PREVALENCE OF BENIGN AND MALIGNANT CANCERS OF HEAD REGION

The purpose of the study was to explore the gender wise prevalence of benign and malignant cancers of head region in Punjab, Pakistan. Data was taken from the OPD record of cancer hospital in Punjab. Significant difference was found among both genders in terms of occurrence of benign (X 2 =31.327, P= .037) as well as malignant cancers of head region (X 2 = 42.910, P&lt;.001). Among both genders, nasal polyp as benign cancer was found highly prevalent. However, Squamous Cell Carcinoma of tongue was found highest (52.6%) among males whereas squamous cell carcinoma of soft palate was found highest (39.3%) among males as malignant cancers of head region. In conclusion, prevalence of benign as well as malignant cancer of head region varies gender wise in Pakistani population.

Transoral Robotic surgery - excision of Tongue base Tumour with the Entire Hyoid bone in a Salvage Setting.

Objectives - Transoral robotic surgery (TORS) is an already well established modality of treatment for early stage oropharyngeal cancer. This case report will throw light on the role of TORS as a treatment option for oropharyngeal cancer in a salvage setting. Methods - This is a case of a 69 year old patient who was a follow up case of carcinoma base of tongue, status - post concurrent chemoradiation who presented with residual disease at the primary site. Results - TORS was used as a successful treatment modality for base of tongue carcinoma in a salvage setting. The surgical procedure included removal of the entire hyoid bone in toto along with the tumour which is not reported in literature. The procedure also helped us in achieving an R0 resection. Conclusion - TORS should be considered as an important management modality for tongue base tumours in upfront as well as salvage setting.

Tissue Transfer After Tongue Resection: Micro-Vascular Reconstruction Using Radial Artery Free Flap versus Reconstruction by Split Thickness Skin Graft in T2 Lesions of Tongue Carcinoma.

To compare postoperative complications, functional rehabilitation, surgical outcomes of the radial artery forearm free flap (RAFFF) and split thickness skin graft (STSG) reconstruction of postsurgical defect in T2 lesions of cancer oral cavity. Observational Prospective comparative study. Academic tertiary referral centre. In our study of forty four patients, after tumour resection, half underwent reconstruction using RAFFF (Group I) and another half by STSG (Group II). All of the patients were followed postoperatively to determine and compare their functional outcomes related to donor site and recipient site complications, speech, deglutition and mouth opening. The speech intelligibility and deglutition were each assessed using Articulation Handicap Index and Vedio-fluoroscopy using the Functional oral intake scale. Operative time for STSG reconstruction was shorter at 2.2 ± 0.97 SD hours compared to 5.9 ± 1.24 SD hours for RAFFF reconstruction. Hospital stay was 8.3 ± 1.19 SD days for STSG patients and 12.6 ± 1.7 SD days for RAFFF patients. Thefunctional outcomes of speech quality and swallowing were near comparable in both groups but the donor site complications were significant in theRAFFF group. Operative time, hospital stay anddonor site complications are both significantly reduced with the STSG as opposed to RAFF. Functional and oncologic results of both methods are near comparable. To conclude, STSG can be used for reconstruction of thepost-surgical defects in T2 lesions of thetongue.

Evidence for etiologic field changes in tongue distant from tumor in patients with squamous cell carcinoma of the oral tongue.

Oral cancer is a paradigm of Slaughter's concept of field cancerization, where tumors are thought to originate within an area of cells containing genetic alterations that predispose to cancer development. The field size is unclear but may represent a large area of tissue, and the origin of mutations is also unclear. Here, we analyzed whole exome and transcriptome features in contralateral tumor-distal tongue (i.e. distant from the tumor, not tumor-adjacent) and corresponding tumor tissues of 15 patients with squamous cell carcinoma of the oral tongue. The number of point mutations ranged from 41 to 237 in tumors and from one to 78 in tumor-distal samples. Tumor-distal samples showed mainly clock-like (associated with aging) or tobacco smoking mutational signatures. Tumors additionally showed mutations that associate with cytidine deaminase AID/APOBEC enzyme activities or a UV-like signature. Importantly, no point mutations were shared between a tumor and the matched tumor-distal sample in any patient. TP53 was the most frequently mutated gene in tumors (67%), whereas a TP53 mutation was detected in only one tumor-distal sample, and this mutation was not shared with the matched tumor. Arm-level copy number variation (CNV) was found in 12 tumors, with loss of chromosome (Chr) 8p or gain of 8q being the most frequent events. Two tumor-distal samples showed a gain of Chr8, which was associated with increased expression of Chr8-located genes in these samples, although gene ontology did not show a role for these genes in oncogenic processes. In situ hybridization revealed a mixed pattern of Chr8 gain and neutral copy number in both tumor cells and adjacent nontumor epithelium in one patient. We conclude that distant field cancerization exists but does not present as tumor-related mutational events. The data are compatible with etiologic field effects, rather than classical monoclonal field cancerization theory. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Ultrasound-assisted resection of oral tongue cancer

Background In surgical resection of squamous cell carcinoma of the oral tongue (SCCOT), achieving clear margins is important for prognosis. Insufficient histopathological margins are common, particularly deep margins. Aims/objectives The aim of the present study was to determine whether ultrasound (US)-assisted resection could decrease the proportion of insufficient histopathological deep margins in SCCOT. Material and methods 34 patients with SCCOT undergoing US-assisted resection (study group) were compared to 76 whose resections were performed without US (conventional group). Outcome measures were insufficient deep histopathological resection margins and mean difference in deep margins. Results Insufficient deep resection margins (<5.0 mm) were seen in 8 of 34 (23.5%) in the study group, compared to 31 of 76 (40.8%) in the conventional group, unadjusted RR 0.58 [95% CI 0.30–1.12; p = .11], adjusted RR 0.82 [95% CI 0.35–1.92; p = .64]. Unadjusted mean difference was 1.4 mm (95% CI 0.1–2.7, p = .04), adjusted mean difference 1.1 mm (95% CI −2.7 to 0.5, p = .19). Conclusions Intraoperative US can visualize the deep resection margins in T1/T2 SCCOT. US-assisted resection seems to decrease the number of insufficient histopathological deep margins, though the results are not statistically significant. Comparatively good results in the conventional group is one explanation for the lack of significance. Clinicaltrials.gov ID NCT04059861

Malignant Peripheral Nerve Sheath Tumor of Tongue: A Rare Tumor of Oral Cavity

Malignant peripheral nerve sheath tumor (MPNST) is a rare tumor of oral cavity. Tongue is an extremely rare site for MPNST. We present a rare case of MPNST of tongue in a 34-year-old male. Presentation remains same as carcinoma of tongue but histopathology and immunohistochemistry help to establish the diagnosis. Biopsy of lesion was suggestive of malignant spindle cell neoplasm. On immunohistochemical examination, tumor cells were immunopositive for vimentin and S100 and SMA. Patient underwent surgery followed by adjuvant radiotherapy in order to reduce the risk of recurrence.

Histopathological prognosticators and their clinicopathological correlation in oral squamous cell carcinomas of the tongue.

Tongue carcinomas account for 25%-40% of intraoral squamous cell carcinomas (OSCCs). Although TNM staging systems is an international standard for cancer reporting, prognosis evaluation, and treatment planning, multiple histopathological risk assessment predictors such as tumor thickness (TT), tumor shape, tumor growth pattern, and invasive malignancy grading scoring systems have been studied and should form a basis for prediction and prognostication of such aggressive carcinomas. To evaluate and characterize the histomorphological prognostic indicators in OSCCs of tongue and compare it with OSCCs of other anatomic sites within the oral cavity. Furthermore, to elucidate the significance of histopathological indicators in predicting prognosis of tongue squamous cell carcinomas (SCCs). Forty SCC cases with 20 each of tongue and 20 from other intraoral sites were retrieved from department archives. Clinical data and staging were obtained for each case. Histomorphological parameters including pattern of invasion (POI), tumor budding (TB), depth of invasion (DOI), TT, lymphocytic host response, tumor-associated tissue eosinophilia (TATE), vascular invasion, perineural invasion (PNI), and muscular invasion were assessed. The results were statistically evaluated. TB, DOI, and sarcolemmal spread were significant histologic predictors in tongue SCC. Upon correlation of histomorphological parameters with clinical staging, TT, POI, and TATE were observed to be significantly correlated (P ≤ 0.05). The histomorphological risk assessment model may serve as important addition to the existing prognosticators and may be used as a prognostic index to help plan and individualize treatment protocol in cases with aggressive high-risk disease for whom the use of multimodality treatment seems beneficial.

Halofuginone inhibits tumor migration and invasion by affecting cancer-associated fibroblasts in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions, with a high rate of metastasis. Cancer-associated fibroblasts (CAFs) play critical roles in tumor growth, metastasis and invasion, making them attractive therapeutic targets for cancer treatment. As an old anti-coccidiosis drug for poultry, Halofuginone (HF) has also been reported to possess anti-fibrosis and anti-cancer activities in the recent decades. However, whether it works by targeting CAFs in OSCC, and the mechanisms involved remain unclear. In the present study, we observed HF dose-dependently inhibits OSCC-derived CAF viability and proliferation. Meanwhile, HF decreased the expressions of α-SMA, FSP-1 and PDGFRβ, markers of the malignant phenotype of CAFs, both at mRNA and protein levels. Furthermore, functional studies demonstrated that HF dramatically attenuates the promotion effect of CAFs on OSCC cell migration and invasion. Mechanistically, the inhibition of MMP2 secretion and the upstream TGF-β/Smad2/3 signaling pathway played an important role in these processes. In the orthotopic transplanted tongue carcinoma in mice model, we confirmed that HF administration inhibited tumor growth and lymph node metastasis (LNM) with reduced CAF population, MMP2 expression and collagen deposition in tumor. Altogether, these results indicate that HF can inhibit the migration and invasion of OSCC by targeting CAFs, which will provide new ideas for the treatment of OSCC.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Squamous-columnar junction of Von Ebner's glands may be a significant origin of squamous cell carcinomas in the base of the tongue.

The histological origin of base of the tongue (BOT) carcinomas is still elusive, and most studies have been focusing on the lingual tonsil. In this study, we sought to identify the existence of the squamous-columnar junction (SCJ) in the human Von Ebner's glandular duct and explored the potential of that in forming squamous cell carcinomas in BOT. The specific genomes of BOT carcinoma were acquired and screened out by The Cancer Genome Atlas (TCGA) database analysis. The 4-nitroquinoline-1-oxide (4-NQO)-treated mouse model was used to explore the transformation of SCJ during cancerization. We used immunohistochemistry to confirm the characteristics of SCJ in human Von Ebner's gland, which were further compared with those in the anus and cervix. The SCJ in the human Von Ebner's glandular duct was found to be similar to that of the cervix and anus. The transformation zone in the 4-NQO-treated mouse model had a multilayered epithelium structure similar to that of HPV16-transgenic mice. In human, the transformation zone of Von Ebner's gland is also similar to that of the cervix and anus. It is the first time that the existence of SCJ in the opening of the human Von Ebner's glandular duct was confirmed. The SCJ of Von Ebner's glands may be a significant origin of squamous cell carcinomas in BOT.

Frequency of Skip Metastasis to the Cervical Lymph Nodes in Oral Squamous Cell Carcinoma

Background: Oral Squamous Cell Carcinoma (OSCC) commonly spreads across regional lymph nodes. Presence or lack of metastasis to the cervical lymph nodes is an essential prognostic factor. The regional metastatic pattern to the cervical lymph nodes is defined as the orderly involvement of the successive anatomical lymph node levels. When the sequential order of involvement is lost and metastases are found at a lower level without involving the first echelon nodes or groups of intermediate nodes, then it is called skip metastases. Knowledge of Skip metastases will allow patients to prevent from receiving under and overt therapy. Current treatment of oral squamous cell carcinoma is primary resection followed by elective/therapeutic neck dissection. Regarding neck dissection, there is a dilemma that up to which level should be performed. Some prefer up to level III and some prefer up to level IV based on evidence of skip metastasis to level IV. This study conducted to find out the frequency of skip metastasis and its pattern according to the site, size and grading of primary oral squamous cell carcinoma.&#x0D; Materials and methods: This was a cross sectional study performed in between August 2018 to September 2019 among 58 patients having histologically proven oral squamous cell carcinoma of tongue, buccal mucosa and retro molar trigone undergoing elective and therapeutic neck dissection. Cervical lymph nodes along with fibro-fatty tissue from patients underwent neck dissection except super selective neck dissection were fixed with 10% formalin in separate containers. The containers were marked with nodal level and sent to pathology department for histopathological examination.&#x0D; Results: Out of 58 patients, 32 (55.2%) had cervical nodal metastasis on postoperative histopathology report, 26 (44.8%) patients had no nodal metastasis and 7 (12.1%) developed skip metastasis. Oral squamous cell carcinoma of tongue was found to be the most frequent site to develop skip metastasis to the cervical lymph node. Also, skip metastases were relatively higher in greater tumour grading and T-stages.&#x0D; Conclusion: Chances of skip metastasis should be considered during treatment planning, especially for oral squamous cell carcinoma of the tongue. For the majority of cases with N0 neck, elective neck dissection up to level III should be performed. In case of carcinoma of Tongue, high-grade tumour and advanced T-stages, elective neck dissection should be performed up to level IV.&#x0D; IAHS Medical Journal Vol 4(2), December 2021; 36-40

Oncological outcomes of compartmental surgery and wide local excision in oral tongue and floor of the mouth cancer

ObjectivesOral tongue carcinomas represent more than half of the tumors arising in the oral cavity, a site with a high cancer specific mortality and impact on quality of life. Current guidelines are lacking for a standardized surgical approach of these tumors. The aim of this study is to compare two currently adopted surgical strategies, compartmental surgery (CTS) and wide local excision (WLE), with loco-regional control as the main oncological endpoint. Materials and methodsAn observational retrospective multicentric study was carried out enrolling a cohort of patients affected by oral tongue or floor of the mouth squamous cell carcinoma and surgically treated in 4 international tertiary referral centers. Survival analysis was performed by propensity-score matching approach and multivariable Cox regression analysis. ResultsA cohort of 933 patients was enrolled. CTS was applied in 113 patients (12.1%) and WLE in 820 (87.9%). Analyzing a propensity-score matched cohort (98 CTS vs. 172 WLE) and applying a survival multivariable modeling strategy on the whole cohort, both confirmed that CTS and WLE are comparable and oncologically safe. Parameters such as number of positive lymph nodes, depth of invasion, and lymphovascular invasion still represent the key prognosticators. ConclusionThe main goals for surgical resection of oral cancer remain its three-dimensional circumferential clearance with adequate margins and en-bloc removal of the tumor-lymph node tract, independently of the technique adopted (CTS or WLE). Further prospective studies including quality of life evaluation are needed to better understand if one of these approaches can provide superior functional outcomes.

Chemosensory Functions After Glossectomy-A Cross-Sectional Pilot Study.

To evaluate potential interactions and compensatory mechanisms of subjectively impaired taste function with ortho- and retronasal olfaction after glossectomy. In this cross-sectional pilot study, chemosensory functions were assessed in 25 patients with tongue carcinomas after glossectomy. The orthonasal-, retronasal-, and gustatory functions were tested with a mean time of 25 months after surgery with the Sniffin' Sticks odor identification test kit (ISST), the Candy Smell-27 test (CST-27) and the Taste strip test (TST). Visual analog scales (VAS) were additionally used for self-assessment of taste, flavor perception, and odor ranging from 0 (no perception) to 10 (excellent perception) and further correlated with our psychophysical evaluated outcome measures. The TST, ISST, and CST-27 tests revealed that only eight (32%) and 13 (52%) glossectomy patients had normal taste and orthonasal function, e 21 (84%) patients showed normal retronasal function. Importantly, neither extent of resection and reconstruction nor prior radiotherapy affected chemosensory functions. Contrary, 20 (80%) patients rated their taste and flavor perception as acceptable (VAS >5). Results of the TST, ISST, and CST-27 tests did not correlate with the equivalent self-assessments of taste (p=0.260, r=0.234), odor (p=0.588, r=-0.114), and flavor (p=0.728, r=0.073) perception. There was a significant discrepancy between self-perception of taste and flavor and assessed gustatory function after glossectomy. A contribution of the intact retronasal olfactory system could be a possible explanation of our results. 4 Laryngoscope, 133:375-382, 2023.

Squamous cell carcinoma of the tongue: subtypes and morphological features affecting prognosis.

Squamous cell carcinoma (SCC) is the most common histological type of mobile tongue carcinoma. The incidence of mobile tongue carcinoma is decreasing in some countries owing to decreasing exposure to risk factors, but it has been reported to be increasing in younger people. The majority of mobile tongue cancers are conventional SCCs. Pathological diagnosis of conventional SCC is relatively easy. However, mobile tongue SCCs involve several subtypes that have distinct pathological features and biological behaviors. Some subtypes are relatively rare, and the pathological subtype influences treatment decision-making. Therefore, the recognition of SCC subtypes is crucial for proper treatment. In this review, we summarize nine SCC subtypes, including conventional SCC and highlight their pathological characteristics. We also report some morphological factors, such as the pattern of invasion, budding, desmoplastic reaction, lymphovascular invasion, and perineural invasion, which could be predictive of prognosis. As some morphological factors are closely associated with prognosis, pathologists may need to evaluate additional factors in pathological reports of near features. In summary, we highlight the basic knowledge of mobile tongue SCC with an emphasis on pathological subtypes, morphological features, and their relationship. We provide information to further elucidate SCC in the oral region.

Methylene blue for the treatment of oral mucositis related to radiation therapy of head and neck cancers: An uncontrolled cohort.

194 Background: Oral mucositis is a feared complication of radiation therapy of head and neck cancers, causing severe pain that affects oral functioning, nutrition, and quality of life, as well as therapy non-adherence or failure. Growing reports suggested that methylene blue (MB) oral-rinse was an effective and safe treatment for this oral pain. Methods: In order to evaluate the efficacy and safety of MB oral-rinse for the treatment of oral pain from mucositis in patients treated with radiation therapy of head/neck, we retrospectively evaluated patients who experienced refractory pain despite conventional therapy. Results: We identified 58 patients who received MB oral-rinse. Most were receiving treatment for squamous cell carcinoma of the tongue (n = 26, 44.83%) and squamous cell carcinoma of the tonsil (n = 14, 24.1%). The most common cancer therapy used was chemotherapy plus radiation (n = 23, 39.66%). The median duration of symptoms was 14 days. The mean NRS pain score before MB oral-rinse therapy was 7.59 (±1.68 standard deviation [SD]; median 8), and after therapy, 2.05 (±2.20 SD; median 2) ( P&lt; 0.0001). The mean oral function scores (ability to talk, chew, and swallow) before MB oral-rinse therapy was 3.55 (±1.33 standard deviation [SD]; median 3.5), and after therapy, 0.52 (±0.86 SD; median 0) (P &lt; 0.0001). Among 58 patients, n = 11; 18.92% had percutaneous feeding tubes placed before using MB oral rinse. Of those, four (36%) were soon removed after pain was controlled using MB. A few patients had PEG tubes inserted despite using MB oral rinse (n = 2; 3.44%), one for malnourishment and another for dehydration. Few adverse events were reported (n = 9, 15.48%) Three patients experienced oral burning sensation during the first-time use. One patient discontinued MB oral-rinse use due to cost of pharmacy compounding charge. Other discontinued it for unknown reason. Conclusions: MB oral-rinse is an effective and safe treatment for refractory pain from oral mucositis related to radiation therapy.