Lip and Oral Cavity Cancer Treatment - Stage IV Lip and Oral Cavity Cancer
Standard treatment options:
- 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.)
- Radiation therapy and neck dissection:
- 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).
- Radiation therapy prior to surgery:
Treatment options under clinical evaluation (all stage IV lesions):
- 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.[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.
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.
- 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]
- Novel fractionation radiation therapy clinical trials are under clinical evaluation.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV lip and oral cavity cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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