Contemporary Treatment of Locally Advanced Oral Cancer
At our institution, locally advanced oral cancer is most commonly treated with surgical resection, immediate reconstruction, and adjuvant radiotherapy with or without concurrent systemic therapy depending on final surgical pathologic analysis. There are patients with markedly advanced local or regional disease who unfortunately will have a low probability of cure. We counsel these patients on induction chemotherapy, emphasizing that this is unlikely to result in a smaller volume of surgical resection. In these patients, a good response to induction chemotherapy is more frequently followed by concurrent chemoradiotherapy. We have not been in the practice of commonly recommending definitive chemoradiotherapy for locally advanced oral cancer when upfront surgery is an option. However, as reviewed below, there is a significant rationale for definitive chemoradiotherapy in patients who are surgical candidates, with the hope of good oncologic outcomes, and potential functional organ preservation. The experts who report their experiences in the studies reviewed below provide a strong argument for considering this approach.
KeywordsOral cavity squamous cell carcinoma Treatment Primary chemoradiotherapy Immunotherapy Neoadjuvant therapy Outcome
Compliance with Ethical Standards
Conflict of Interest
David Kim and Ryan Li declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.AJCC 8th Edition. Springer International Publishing. American Joint Commission on Cancer; 2016.Google Scholar
- 2.Altice CK, Benegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Int. 2017;109(2).Google Scholar
- 8.•• Foster CC, Melotek JM, Brisson RJ, Seiwert TW, Cohen EEW, Stenson KM, et al. Definitive chemoradiation for locally-advanced oral cavity cancer: a 20-year experience. Oral Oncol. 2018;80:16–22. One of the largest retrospective studies summarizing a 20-year experience of primary chemoradiation for locally advanced oral cancer and demonstrating favorable survival outcomes and toxicity profiles.CrossRefGoogle Scholar
- 10.Spiotto MT, Jefferson G, Wenig B, Markiewicz M, Weichselbaum RR, Koshy M. Differences in survival with surgery and postoperative radiotherapy compared with definitive chemoradiotherapy for oral cavity cancer: a national cancer database analysis. JAMA Otolaryngol Head Neck Surg. 2017;143(7):691–9.CrossRefGoogle Scholar
- 13.• Elbers JBW, Al-Mamgani A, Paping D, van den Brekel MWM, Jozwiak K, de Boer JP, et al. Definitive (chemo) radiotherapy is a curative alternative for standard of care in advanced stage squamous cell carcinoma. Oral Oncol. 2017;75:163–8. Large retrospective review reporting survival outcomes in patients with advanced oral cavity cancer treated with definitive chemoradiotherapy over a 13-year period.CrossRefGoogle Scholar
- 18.Owosho AA, Tsai CJ, Lee RS, Freymiller H, Kadempour A, Varthis S, et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the Memorial Sloan Kettering Cancer Center experience. Oral Oncol. 2017;64:44–51.CrossRefGoogle Scholar
- 22.Iyer NG, Tan DS, Tan VK, Wang W, Hwang J, Tan NC, et al. Randomized trial comparing surgery and adjuvant radiotherapy versus concurrent chemoradiotherapy in patients with advanced, nonmetastatic squamous cell carcinoma of the head and neck: 10-year update and subset analysis. Cancer. 2015;121(10):1599–607.CrossRefGoogle Scholar
- 24.•• Cohen EEW, Soulieres D, Le Tourneau C, Dinis J, Licitra L, Ahn MJ, et al. Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomized, open-label, phase 3 study. Lancet. 2018. Randomized phase 3 trial comparing pembrolizumab to standard chemotherapy drugs in recurrent or metastatic head and neck cancer, with pembrolizumab demonstrating prolonged overall survival with a favorable side effect profile.Google Scholar
- 26.Burtness B. First-line pembrolizumab for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC): interim results from the phase 3 KEYNOTE-048 study. Presented at: European Society for Medical Oncology Congress; 2018 October 19–23, Munich, Germany.Google Scholar