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Stage III Lip and Oral Cavity Cancer

    Surgery and/or radiation therapy are used, depending on the exact tumor site.[1,2] Neoadjuvant chemotherapy, as given in clinical trials, has been used to shrink tumors and render them more definitively treatable with either surgery or radiation. Neoadjuvant chemotherapy is given prior to the other modalities, as opposed to standard adjuvant chemotherapy, which is given after or during definitive therapy with radiation or after surgery. Many drug combinations have been used as neoadjuvant chemotherapy.[3,4,5,6] Randomized, prospective trials, however, have yet to demonstrate a benefit in either disease-free survival or overall survival for patients receiving neoadjuvant chemotherapy.[7]

    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.
    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 options under clinical evaluation:

    1. Clinical trials for advanced tumors evaluating the use of chemotherapy preoperatively, before radiation therapy, as adjuvant therapy after surgery, or as part of combined modality therapy are appropriate.[3,4,5,6,8,9,10]
    2. Superfractionated radiation therapy.[11]

    Moderately Advanced (Late T2, Small T3) Lesions of the Anterior Tongue

    Standard treatment options:

    1. EBRT with or without interstitial implant is used to treat minimally infiltrative lesions.
    2. Surgery with postoperative radiation therapy is used to treat deeply infiltrative lesions.[2]

    Advanced Lesions of the Buccal Mucosa

    Standard treatment options:

    1. Radical surgical resection alone.
    2. Radiation therapy alone.
    3. Surgical resection plus radiation therapy, generally postoperative.

    Treatment options under clinical evaluation:

    • Clinical trials for advanced tumors evaluating the use of chemotherapy preoperatively, before radiation therapy, as adjuvant therapy after surgery, or as part of combined modality therapy are appropriate.[3,4,5,6,8,9,10,12]

    Moderately Advanced Lesions of the Floor of the Mouth

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