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Stage IV Lip and Oral Cavity Cancer

    Randomized, prospective trials have yet to demonstrate a benefit in either disease-free survival or overall survival for patients receiving neoadjuvant chemotherapy.[1] The use of isotretinoin (13-cis-retinoic acid) daily for 1 year to prevent development of second upper aerodigestive tract primaries is under clinical evaluation.[2]

    Advanced Lesions of the Lip

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    Overview

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    These lesions, including those involving bone, nerves, and lymph nodes, generally require a combination of surgery and radiation therapy.

    Standard treatment options:

    1. Surgery using a variety of surgical approaches, the choice of which is dependent on the size and location of the lesion and the needs for reconstruction. Treatment of both sides of the neck is indicated for selected patients.
    2. Radiation therapy using a variety of therapy techniques, including external-beam radiation therapy (EBRT) with or without brachytherapy, the choice of which is dictated by the size and location of the lesion.

    Treatment option under clinical evaluation:

    • Superfractionated radiation therapy.[3]

    Advanced Lesions of the Anterior Tongue

    Standard treatment options:

    1. Combined surgery (i.e., total glossectomy, sometimes requiring laryngectomy) possibly followed by postoperative radiation therapy may be used to treat selected patients.[4]
    2. Palliative radiation therapy may be used to treat patients with very advanced lesions.

    Advanced Lesions of the Buccal Mucosa

    Standard treatment options:

    1. Radical surgical resection alone.
    2. Radiation therapy alone.
    3. Surgical resection plus radiation therapy, which is generally administered postoperatively.

    Advanced Lesions of the Floor of the Mouth

    Standard treatment options:

    1. A combination of surgery and radiation therapy, which is generally administered postoperatively, is often used.
    2. Preoperative radiation therapy is often used for fixed nodes (≥5 cm).

    Advanced Lesions of the Lower Gingiva

    Standard treatment options:

    • Surgery, radiation therapy, or a combination of both are poor controls for far advanced tumors with extensive destruction of the mandible and with nodal metastases.

    Advanced Lesions of the Retromolar Trigone

    Standard treatment options:

    • Surgical composite resection followed by postoperative radiation therapy.

    Advanced Lesions of the Upper Gingiva

    Standard treatment options:

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

    Advanced Lesions of the Hard Palate

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