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    Lip and Oral Cavity Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IV Lip and Oral Cavity Cancer

    continued...

    Standard treatment options:

    • Surgery in combination with radiation therapy is generally used to treat lesions that are extensive and infiltrating.

    Treatment options for management of lymph nodes:[5]

    Patients with advanced lesions should have elective lymph node radiation therapy or node dissection. The risk of metastases to lymph nodes is increased by high-grade histology, large lesions, spread involving the wet mucosa of the lip or the buccal mucosa in patients with recurrent disease, and invasion of muscle (orbicularis oris).

    Standard treatment options:

    1. Radiation therapy alone or neck dissection:
      • N1 (0-2 cm).
      • N2b or N3; all nodes smaller than 2 cm. (A combined surgical and radiation therapy approach should also be considered.)
    2. Radiation therapy and neck dissection:
      • N1 (2-3 cm), N2a, N3.
    3. Surgery followed by radiation therapy is indicated for the following:
      • Multiple positive nodes.
      • Contralateral subclinical metastases.
      • Invasion of tumor through the capsule of the lymph node.
      • N2b or N3 (one or more nodes in each side of the neck, as appropriate, >2 cm).
    4. Radiation therapy prior to surgery:
      • Large fixed nodes.

    Treatment options under clinical evaluation (all stage IV lesions):

    1. Chemotherapy has been combined with radiation therapy in patients who have locally advanced disease that is surgically unresectable.[6,7,8,9]

      A meta-analysis of 63 randomized, prospective trials published between 1965 and 1993 showed an 8% absolute survival advantage in the subset of patients receiving concomitant chemotherapy and radiation therapy.[10][Level of evidence: 2A] Patients receiving adjuvant or neoadjuvant chemotherapy had no survival advantage. Cost, quality of life, and morbidity data were not available; no standard regimen existed; and the trials were felt to be too heterogenous to provide definitive recommendations. The results of 18 ongoing trials may further clarify the role of concomitant chemotherapy and radiation therapy in the management of oral cavity cancer.

      The best chemotherapy to use and the appropriate way to integrate the two modalities is still unresolved.[11]

      Similar approaches in the patient with resectable disease, in whom resection would lead to a major functional deficit, are also being explored in randomized trials but cannot be recommended at this time as standard.

    2. Clinical trials for advanced tumors evaluating the use of chemotherapy preoperatively, before radiation therapy, or as adjuvant therapy after surgery are appropriate.[6,12,13,14,15,16,17,18,19]
    3. Novel fractionation radiation therapy clinical trials are under clinical evaluation.[20]
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