Treatment Of Advanced Oral Cancer Research Articles

Evaluation of alloplastic mandibular reconstruction combined with a radial forearm flap compared with a vastus lateralis myocutaneous flap as the first approach to two-stage rehabilitation in advanced oral cancer

After continuity resection of the mandible, reconstruction of continuity with a reconstruction plate and soft tissue can be an alternative to immediate osseous reconstruction in patients with advanced oral cancer. We evaluated exposure of the plate in such reconstructions by comparing the results of a radial forearm flap (RFF) with a vastus lateralis myocutaneous flap (VLMF). We also analysed the resection margins and the incidence of secondary osseous reconstructions after one year free from relapse. We retrospectively examined all 48 mandibular reconstructions in which a reconstruction plate and RFF or VLMF had been used between 2007 and 2016. Exposure rates of plates were assessed and local (size and site of resection) and systemic risk factors (age, sex, treatment with radiation, and smoking) evaluated. Reconstruction plates, together with a RFF, were significantly more likely to be exposed than those with a VLMF (p = 0.01). There was significantly more exposure in the RFF group in mandibular defects larger than 6 cm, in contrast to the VLMF group (p = 0.002). Younger age (p < 0.001), lower body mass index (BMI) (p = 0.05) and smoking (p = 0.011) led to more exposure. In seven cases a second operation was necessary due to macroscopically invaded or close margins. Thirty-one patients had no bony reconstruction because of local recurrence, distant metastases, inadequate resection margins, poor general condition, or a second (different) tumour. Exposure of the plate after mandibular reconstruction happens less often with the VLM flap than with the RFF. The two-step approach can be an option in the treatment of advanced oral cancer.

A worldwide comparison of the management of surgical treatment of advanced oral cancer

IntroductionMicrovascular surgery following tumor resection has become an important field of oral and maxillofacial surgery (OMFS). Following the results from management of T1/T2 floor-of-mouth and tongue squamous cell carcinoma (SCC) in German-speaking countries, Europe, and worldwide, this paper presents specific concepts for the management of resection and reconstruction of T3/T4 SCC of the maxillary and mandibular alveolar process and tongue. MethodsThe DÖSAK questionnaire was distributed in three different phases to a growing number of maxillofacial units worldwide. Within this survey, clinical patient settings were presented to participants and center-specific treatment strategies were evaluated. ResultsA total of 188 OMFS units from 36 different countries documented their treatment strategies for T3/T4 maxillary and mandibular alveolar process and tongue SCC. The extent of surgical resections and subsequent reconstructions is more consistent than with T1/T2 tumors, although the controversy surrounding continuity resections and mandible-sparing procedures remains. For continuity resection of the mandible the fibula free flap is the most frequently used bone replacement, whereas maxilla reconstruction concepts are less consistent, ranging from locoregional coverage concepts and different microvascular reconstruction options to treatment via obturator prosthesis. ConclusionResults from treatment strategies for T3/T4 tumors underline the limited evidence for the appropriate amount of resection and subsequent reconstruction process, especially in cases involving the mandible. Prospective randomized trials will be necessary in the long term to establish valid treatment guidelines.

Intra-arterial infusion of recombinant adenoviral human p53 gene combined chemotherapy for advanced oral cancer: A phase II double-blind randomized clinical trial.

5507 Background: The p53 tumor suppressor gene has been shown as having multiple anti-tumor functions and being capable of enhancing the efficacy of chemo-therapy. This study is to investigates clinical outcomes of intra-arterial infusion ofrecombinant adenoviral human p53 gene (rAd-p53) combined with chemotherapy in treatment of advanced oral cancer. Methods: Ninety-nine patients with stage III or IV oral carcinoma, satisfying with the inclusion criteria, were randomly allocated to Group I (G1: n=35; rAd-p53 plus chemotherapy), Group II (G2: n=33; rAd-p53), or Group III (G3: n=31; chemotherapy). Intra-artery infusion of rAd-p53 were given through superficial temporal artery reverse intubation at a dose 1-4 ×1012 viral particles (VP) , once every 3 days for 6 times. Chemotherapy regimen consisted of oxaplatin 200 mg/m2 on day1, bleomycin 8 mg/m2 on day 2, 6, 8 and Methotrexate 30 mg/m2 on day1, 8, for squamous cell carcinoma (SCC), and oxaplatin 200 mg/m2 on day1, 5-Fu 200 mg/m2 on day1,3 and cyclophosphamide 400 mg/m2 on day2, 8 for adenoid cystic carcinoma (ACC). Results: The complete response rate (CR) in G1 (48.5%) was significantly higher than in G2 (16.7%) and G3 (17.2%). The overall response rates (RR) were 88.6%, 54.5%, and 51.6% for G1, G2 and G3, respectively. The 3-year overall survival (OS) of G1 (82.9%) was significantly higher than the patients in G2 (60.6%) and G3 (58.1%). All those patients receiving rAd-p53 had a self-limited fever. Positive Bax immunostaining was detected in all the patients receiving rAd-p53. Conclusions: Intra-arterial infusion of combined rAd-p53 and chemotherapy may represent an alternative to the current standard treatment for the late stage oral carcinoma.

Two elderly patients with advanced maxillary gingival carcinoma with complete response to concurrent radiotherapy and S-1 chemotherapy

The use of the novel oral fluoropyrimidine anticancer drug S-1 as a single agent or in combined chemotherapy has been reported to be useful for the treatment of advanced oral cancer. We report two elderly patients with advanced oral cancer who achieved complete response (CR) after concurrent radiotherapy and S-1 chemotherapy. Patient 1 was an 81-year-old woman who had a 50 mm × 40 mm tumor erosion in the right upper gingival region. At 2.5 years after the end of concurrent radiotherapy and S-1 chemotherapy, tumor relapse was observed, although CR continued temporarily. The patient died 3 years after the end of concurrent radiotherapy and S-1 chemotherapy due to tumor relapse and high blood pressure resulting in deterioration of patient condition. Patient 2 was an 89-year-old woman who had a 40 mm × 30 mm tumor ulcer in the right gingiva. Neither relapse nor metastasis was seen, and patient condition remained good for the 3 years after concurrent radiotherapy and S-1 chemotherapy. In both patients, MRI showed that the tumor had deeply invaded the palatal bone, almost reaching the nasal cavity, with metastasis to the right upper superior internal jugular nodes. In both patients, biopsy showed a well-differentiated squamous cell carcinoma. Concurrent radiotherapy and S-1 chemotherapy induced CR without severe adverse effects.

Preoperative radiochemotherapy in the treatment of advanced oral cancer: Outcome of 276 patients

The aim of this study was to review survival and locoregional control in patients with advanced oral and oropharyngeal squamous cell carcinoma treated by multimodal therapy with preoperative radiochemotherapy and radical surgery. Retrospective cohort study. Included in this analysis are 276 consecutive patients with UICC disease stages III and IV (T2: 13.0%; T3: 16.7%; T4: 70.3%; N0: 29.7%; N1: 20.3%; N2: 45.3%; N3: 4.7%; stage III: 16.3%; stage IV: 83.7%). All patients received preoperative radiochemotherapy (50Gy, Mitomycin and 5-Fluorouracil) and radical locoregional resection. Median surveillance period was 101.4 months (24-202 months). 5-year overall survival probability was 53.9%. 5-year local control probability was 70.2%. These results underline the reliability of preoperative treatment of patients with oral and oropharyngeal cancer.

PD9 Evidence based treatment of advanced oral cancer: Management of the mandible

PD9 Evidence based treatment of advanced oral cancer: Management of the mandible

5-Fluorouracil and cisplatin in the treatment of advanced oral cancer

The benefit of the effect of chemotherapy in patients with advanced head and neck squamous cell tumors have been demonstrated by recent meta-analyses of randomized studies. However, the role of chemotherapy—especially in advanced oral cancer—is not fully clear, because of the very small amount of phase II literature available. From January 1994 to December 2000, a total of 44 pts aged 33–75 years (mean age 60 years) with advanced and histologically proved squamous cell carcinoma's of the oral cavity received at least one chemotherapy course. Seven patients had stage III and 37 stage IV disease. The chemotherapy was the initial therapy in a group of 21 patients. In a second group of 23 patients the chemotherapy was delivered after relapse of their disease. The pre-chemotherapy treatment of the second group was radiotherapy in 11, surgery in 4, combination of radiotherapy and surgery in 8 patients. The chemotherapy regimen consisted of cisplatin 100 mg/m 2 in 3-h infusion, day 1 and 5-FU 1000 mg/m 2 in 24-h infusion, days 1–5. Treatment was repeated every 21 days. A total of 154 treatment courses (3.5 per patient, ranged 1–10) were administered. Myelotoxicity, nausea and vomiting were the major treatment complications. The overall response rate to the induction chemotherapy was 52.3%, with 19% complete (CR), and 33.3% partial response's (PR) and to the chemotherapy for recurrent/metastatic disease 30.4% with 8.7% CR, and 21.7% PR. No difference was found in the median survival of the two subgroups (12 months). The median survival of the responders was 15 months (95% CI 11.3–18.7 months), and of the non-responders 9 months (95% CI 5.6–12.4 months) ( P=0.0067). Chemotherapy with cisplatin and 5-FU combination is effective in pts with advanced squamous cell oral cancer and appears to improve the survival of patients who have a good response.

The role of neoadjuvant and adjuvant chemotherapy regimens consisting of different combinations of drugs in the treatment of advanced oral cancer.

We performed a retrospective analysis on the effect of neoadjuvant chemotherapy with three cycles of methotrexate (100 mg/m2 on day 1), cisplatin (90 mg/m2 on day 1) and bleomycin (20mg/m2 on day 1-5) with 21 d gap between each cycle in 44 patients with advanced squamous cell carcinoma of the cheek, lip and tongue followed by surgery and adjuvant chemotherapy consisting of cisplatin (90 mg/m2 on day 1), Mitomycin C (6 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2 120 h continuous infusion from day 1) repeated every 3 weeks for three cycles. Following induction chemotherapy, complete response was observed in 11 out of 44 patients (25%), and a partial response in a further 28 patients (64%). The overall median survival of all patients was 29 months and those in stage III and stage IV were 30 and 15 months respectively (P< 0.001). The median duration of the time to relapse in patients who responded to adjuvant chemotherapy was 28 months. The main toxic effect was vomiting followed by hematological toxicity. No treatment-related deaths occurred. The regimen showed a significant response, encouraging median survival and a good tolerability profile.

Cervical-pectoral flaps in the treatment of advanced oral cancer

Cervical-pectoral flaps in the treatment of advanced oral cancer

Combined therapy of oral cancer bleomycin and radiation: A clinical trial

A concurrent randomised controlled clinical trial to evaluate a combination of Bleomycin and radiation as against radiation only in the treatment of advanced oral cancer has been conducted at the Cancer Institute, Madras, since 1971. All T3 and T4 previously untreated oral squamous cell carcinomas with N0, N1 and N2 regional nodes, or N3 nodes confined to the submandibular region, without systemic metastases or gross infiltration of the temporal and infratemporal fossa producing total trismus, and in decent general health were eligible for the trial. Patients with gross active pulmonary tuberculosis were excluded, as were recurrent carcinomas. Age, external fungation of growth or radiological bone invasion were no bar. Randomisation was done by the sealed envelope technique. The study group received concurrent fractionated cobalt 60 teletherapy using two opposing fields and 10-15 mg of Intra-arterial or Intravenous Bleomycin. The controls received fractionated cobalt teletherapy and i.v. or i.m. distilled water on the same protocol as the Bleomycin cases. All cases were evaluated double blind 8 weeks after the end of radiation therapy, and were classified as 'favourable response' or 'failure'. The criterion of 'favourable response' was 'total clinical healing of the tumour within the volume of irradiation with no subsequent recurrence within that volume, whatever the length of follow up'. Anything else was reported as a failure. A long term follow up of 3 years is also available. 136 cases have completed the trial. The favourable response in the study group was 77% as against 20.9% in the control group. The differential response is statistically significant. The present study is the fourth in the series of combined therapeutic trials conducted in advanced oral squamous cell carcinoma since 1958. (Krishnamurthi and Shanta, 1963, 1965, 1967 and 1971). A concurrent randomised controlled clinical trial to evaluate the combination of Bleomycin and radiation as against radiation only in treatment of advanced oral cancer has been conducted at the Cancer Institute, Madras since 1971.

Cervical-pectoral flaps in the treatment of advanced oral cancer.

Twenty-two of 90 patients with carcinoma of the anterior oral cavity treated at the Minneapolis Veterans Administration Hospital from 1965 through 1973 had advanced lesions - tumors attached to the mandible and/or more than 3 cm in size. These patients were treated by primary radical neck dissection, en bloc excision, and segmental mandibulectomy. A cervical-pectoral flap combination was used for reconstruction. The functional and cosmetic results were excellent. Patient survival and cure rate compare favorably with other series. We emphasize the need for wide initial resection with immediate reconstruction.

Immediate functional restoration of the mandible after surgical treatment of advanced oral cancer

Immediate functional restoration of the mandible after surgical treatment of advanced oral cancer

Immediate functional restoration of the mandible after surgical treatment of advanced oral cancer. A simple prosthesis.

A simple mandibular prosthesis, fabricated from siliconized rubber (Silastic) and Kirschner wires at the time of surgery, has been used to replace large segments of mandible after resections of squamous cell cancers in 25 patients. It was cosmetically satisfactory and was adequate to support the tongue and lower facial structures, allowing swallowing and good control of saliva, in the 16 patients who retained the prosthesis. Mandibular support and spacing were preserved during the period of tumor follow-up. At the present time, we would not recommend placement of the prosthesis in a heavily irradiated field since it failed in all four of such attempts. The prosthesis proved satisfactory for over four years in three patients, and over two years in an additional four, suggesting that it may be considered as a definitive mandibular replacement as well as a temporary measure.