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

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.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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