Profile of patients with oral cavity cancer seen at the Department of Ear Nose Throat – Head and Neck Surgery of the Bicol Medical Center

Objective@#To determine the profile of patients with oral cavity cancer seen at the Ear, Nose and Throat – Head and Neck Surgery (ENT-HNS) Department of the Bicol Medical Center from January 2018 to December 2020.@*Methods@#Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Medical records of patients with oral cavity lesions with malignant biopsy results seen at the Bicol Medical Center Department of ENT-HNS from January 2018 to December 2020. @*Results@#Records of 42 patients were included, 30 (71%) male; 12 (29%) female with the mean age of 62 ± 10.02 (range 34 to 80 years old). Squamous cell carcinoma was the most common histopathologic diagnosis (38/42; 91%), mostly affecting the anterior tongue (16/42; 38%) and buccal regions (14/42; 33%). Most tumors were in advanced stages: 25/42 (59%) in stage IVA; 7 (17%) in stage IVB. A total of 61% (17) of 28 oral cavity cancer patients with recorded risk factors practiced a combination of two or three high risk habits (betel nut chewing, tobacco smoking, alcoholic beverage intake) and a third practiced all three (10/28; 36%).@*Conclusion@#The profile of oral cavity cancer patients in our study is different from the reported profiles in Asia and European and US counterparts. Our profile patient is a married male farmer in the 7th decade of life with poor dental hygiene and advanced stage IV squamous cell carcinoma of the tongue and buccal region, and combined habits of regular alcoholic beverage drinking, chronic tobacco smoking, and/or betel nut chewing, who lives in coastal or mountainous communities where access to health care may be limited.

Carga por mortalidad del cáncer de labio, cavidad bucal y faringe

Fundamento: un análisis de la tendencia al cambio en la mortalidad del cáncer de labio, cavidad bucal y faringe y la cuantificación del impacto sobre la esperanza de vida en la población cubana puede ayudar a los investigadores y a los responsables de la formulación de políticas de Salud Pública a tener una visión integral de este problema. Objetivo: estimar la carga por mortalidad de cáncer de labio, cavidad bucal y faringe, por sexo, en Cuba en el período comprendido de 2005- 2020. Método: se realizó un estudio descriptivo, de corte transversal en el que se utilizaron series de datos quinquenales. El universo estuvo conformado por todas las muertes por cáncer de labio, cavidad bucal y faringe para los años estudiados. Se utilizó, para cada año y causas, el número de defunciones, se calcularon tasas por 100 000 habitantes y los años de vida potencialmente perdidos por mortalidad. Se calculó, el promedio y se estimó del cambio porcentual anual. Resultados: las tasas de mortalidad fueron entre 7,62 y 12,23 en hombres y 2,60 y 3,74 en mujeres, por 100 000 habitantes. En cuanto a los años de vida dejados de vivir temparanamente, por cáncer de labio, cavidad bucal y faringe se observó que en hombres las tasas asciendieron de 131 en el 2005 a 169 en el 2020 y de 40 a 52 en las mujeres. Concluciones: la carga por cáncer de labio, cavidad bucal y faringe en Cuba ha aumentado, fue superior en hombres, la tendencia es creciente en ambos sexos, por cáncer nasofaríngeo tanto hombres como mujeres fallecieron a edades más tempranas que, por otras localizaciones estudiadas, el cambio porcentual fue superior por cáncer faríngeo.

Background: an analysis of the trend of change in the mortality of cancer of the lip, oral cavity and pharynx and the quantification of the impact on life expectancy in the Cuban population can help researchers and those responsible for formulating health policies. Public to have a comprehensive view of this problem. Objective: to estimate the mortality burden of cancer of the lip, oral cavity and pharynx, by sex, in Cuba in the period 2005-2020. Method: a descriptive, cross-sectional study was carried out in which five-year data series were used. The universe was made up of all deaths from cancer of the lip, oral cavity and pharynx for the years studied. For each year and causes, the number of deaths was used; rates per 100,000 inhabitants and the years of life potentially lost due to mortality were calculated. The average was calculated and the annual percentage change was estimated. Results: mortality rates were between 7.62 and 12.23 in men and 2.60 and 3.74 in women, per 100,000 inhabitants. Regarding the years of life lost early, due to cancer of the lip, oral cavity and pharynx, it was observed that in men the rates rose from 131 in 2005 to 169 in 2020 and from 40 to 52 in women. Conclusions: the burden of cancer of the lip, oral cavity and pharynx in Cuba has increased, it was higher in men, the trend is growing in both sexes, both men and women died at younger ages due to nasopharyngeal cancer than, due to other locations studied, the percentage change was higher for pharyngeal cancer.

Review of the Literature on Oral Cancer: Epidemiology, Management and Evidence-based Traditional Medicine Treatment

Oral cavity cancers are part of the upper aerodigestive tract cancers and represent a significant burden worldwide. Its epidemiology varies from country to country with high frequencies in South East Asian countries. Tobacco and alcohol are the main risk factors. Survival of oral cancer is low i.e., less than 40% in the advanced stage (stage III and IV), diagnosis of oral cavity cancer is based on a complete clinical examination of the oral cavity complete with biopsy, bio-markers are an adjunct to screening and diagnosis of oral cavity cancers, surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic armamentarium of oral cancer but also have limitations. Traditional medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. Prevention of oral cavity cancers includes not only early detection of precancerous and cancerous lesions but also control of risk factors and education of the population. Surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic strategy of oral cancer treatment but also have limitations. Traditional Medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. It is thus desirable to scientifically validate phytochemicals in order to integrate alternative medicine as part of national cancer management strategy. In silico advanced studies on secondary metabolites of medicinal plants traditionally used to treat oral cancer are in progress.

Acantholytic squamous cell carcinoma

@#A 63-year-old Filipino man presented with a one-month history of painful ulceration on the alveolar socket of a molar tooth of the right hemimandible. The patient consulted at a tertiary hospital, where he underwent incisional biopsy.

Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis

This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.

Caracterização do perfil alimentar e nutricional dos sobreviventes de câncer de cavidade oral e grau de adesão às recomendações de prevenção ao câncer emitidas pelo Fundo Mundial de Pesquisa de câncer e Instituto Americano de Pesquisa de Câncer / Characterization of the food intake and nutritional profile of oral cavity cancer survivors and the adherence degree to cancer prevention recommendations issued by the World Cancer Research Fund and the American Institute for Cancer Research Institute

Introdução: Sobreviventes do câncer de cavidade oral (SCCO) em controle normalmente apresentam inúmeras sequelas derivadas do tratamento oncológico, o que pode comprometer sua alimentação e, por extensão, o atendimento às diretrizes de alimentação e peso adequado emitidas pelo Fundo Mundial para Pesquisa do Câncer/Instituto Americano de Pesquisa para o Câncer (WCRF/AICR). Objetivo: Avaliar o perfil alimentar e o estado nutricional de sobreviventes de câncer de cavidade oral e verificar o grau de sua adesão, as diretrizes de alimentação saudável e peso corporal emitidas pela WCRF / AICR. Método: Estudo transversal que avaliou o estado nutricional pela Avaliação Subjetiva Global produzida pelo paciente (ASG-PPP) e índice de massa corporal (IMC) de 20 pacientes. Dados como condição social e histórico clínico foram coletados em prontuário. O consumo alimentar foi avaliado por meio de um diário alimentar de 30 dias. Os dados alimentares e o peso corporal receberam um escore de pontos conforme maior ou menor grau de adesão às recomendações WCRF / AICR. Resultados: 80% dos pacientes encontravam-se com desnutrição moderada ou suspeita de desnutrição pela ASG-PPP. Pelo IMC, 10% dos participantes estavam desnutridos, 45% eutróficos e 35% apresentavam sobrepeso. Foi encontrado escore médio 2,64 ±0.55 de adesão às recomendações de peso adequado e alimentação saudável, demonstrando atendimento de menos de 50% das recomendações WCRF / AICR. Conclusão: Os pacientes SCCO do presente estudo apresentam risco de desnutrição ou estão com desnutrição moderada; e possuem alta sintomatologia, que impacta negativamente na ingestão alimentar e na adesão às recomendações da WCRF / AICR. (AU)

Introduction: Survivors of oral cavity cancer (OCC) under control usually have numerous sequelae resulting from oncological treatment, which can compromise their diet and, by extension, meet the guidelines for diet and proper weight issued by the World Cancer Research Fund International-WCRF and the American Institute for Cancer Research-AICR. Objective: To evaluate the dietary profile and nutritional status of oral cancer survivors and verify the degree of their adherence, the guidelines for healthy eating and body weight issued by WCRF/AICR. Method: Cross-sectional study which assessed the nutritional status by the Subjective Global Assessment produced by the patient (PG-SGA) and body mass index (BMI) of 20 patients. Data such as social condition and clinical history were collected from medical records. Food consumption was assessed using a 30-day food diary. Food data and body weight received a score of points according to a greater or lesser degree of adherence to WCRF/AICR recommendations. Results: 80% of patients were moderately malnourished or suspected of malnutrition by PG-SGA. According to BMI 10% of participants were malnourished, 45% eutrophic and 35% were overweight. An average score of 2.64 ± 0.55 adherence to the recommendations of adequate weight and healthy eating was found, showing compliance with less than 50% of the WCRF/AICR recommendations. Conclusion: Survivor patients of OCC patients from the present study are at risk of malnutrition or have moderate malnutrition; and have high symptomology, which negatively impacts food intake and adherence to recommendations of WCRF/AICR. (AU)

Relationship among areca nut, intracellular reactive oxygen species, and autophagy / 华西口腔医学杂志

The relationship between areca nut as a primary carcinogen and oral cancer has been widely concerned. Areca can change the levels of reactive oxygen species (ROS) and autophagy in cells, and the levels of ROS and autophagy are closely related to the occurrence and development of tumors. This paper reviewed the relationships among areca nut, intracellular ROS, and autophagy.

Oral cancer reconstruction using the pedicled supraclavicular artery island flap: comparison to pectoralis major myocutaneous flap / 中华整形外科杂志

Objective@#To compare the pedicled supraclavicular artery island flap (SCAIF) and the pectoralis major myocutaneous flap (PMMF) for oral reconstruction after cancer resection.@*Methods@#This is a retrospective study from May 2007 to May 2017. Sixty-one patients from the Jiangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanchang University, were included. All the patients underwent oral squamous cell carcinoma resection and pedicled flap reconstruction. Sixteen patients were performed SCAIFs (group A), and 45 were performed PMMFs (group B). The flap survival rate, flap size, flap preparation time, the presence of scar hyperplasia, pigmentation and dysfunction (temporary or permanent) were compared between these two groups.@*Results@#The survival rate of flaps in group A was 93.75% (15/16), and the survival rate of flaps in group B was 95.56% (43/45). There was no statistically significant difference in the survival rate of flaps, the average skin flap size or flap produce time between these 2 groups. There were no scar hyperplasia, pigmentation and dysfunction was observed in group A. However, scar hyperplasia (n=11), pigmentation (n=10) and dysfunction (n=12) occurred in group B. The difference was statistically significant (P<0.05).@*Conclusions@#This study suggests that SCAIF is more reliable, and brings more satisfied outcome, when compared with the PMMF.

Relationship between interleukins in the saliva and oral cavity cancer / 华西口腔医学杂志

Saliva is being attached great importance for its application in illness diagnosis and have more advantage on the diagnose in oral cavity cancer (OCC). Studies have showed that interleukin (IL) in the saliva could be used as a potential biomarker for OCC diagnosis. Moreover, they have a close connection with tumor genesis, invasion, and metastasis in OCC. Therefore, we reviewed research progress on the relationship between salivary interleukins and OCC.

Preventive and therapeutic effects of rhEGF gel on radiation-induced oral mucositis:A clinical observation / 医学研究生学报

Objective Few studies are reported on the prevention and management of oral mucositis(OM) induced by post-operative radiotherapy in patients with oral cavity cancer.This study aimed to investigate the therateutic effect of the recombinant human epidermal growth factor(rhEGF) gel on radiation-induced OM. Methods Sixty-eight cases of radiation-induced OM after surgery for oral cavity cancer were randomly divided into an experimental and a control group of equal number,the former treated with rhEGF gel while the latter with borax mouthwash. Comparisons were made between the two groups of patients in the severity of oral cavity mucous membrane injury,the intensity of radiation-induced oral pain,the in-cidence of oral cavity infection, and the duration of radiotherapy. Results At 3 weeks of radiotherapy,the patients of the experimental group showed mainly mild and moderate OM while the controls chiefly moderate and severe OM,and at 6 weeks,the former exhibited mainly moderate while the latter chiefly severe OM, with statistically significant differences in the incidence rate between the two groups (P<0.01). The experimental group, compared with the controls, had a significantly higher incidence rate of grade-Ⅰ radiation-induced pain (47.1% vs 20.6%,P<0.01),but lower rates of grade-Ⅱ(17.6% vs 32.4%,P<0.01) and grade-Ⅲpain(2.9% vs 20.6%,P<0.01).The rates of oral infection and antibiotics medication were remarkably lower in the experimental group than in the controls(23.5% vs 38.2% and 11.8% vs 26.5%,P<0.05),and the duration of radiotherapy was markedly shorter in the former than in the latter ([42.37±3.14] d vs [48.47±4.39] d, P<0.05). Conclusion The rhEGF gel can significantly reduce the severity of radiation-induced oral mucositis,improve its symptoms,and shorten the time of postoperative radiotherapy for patients with oral cavity cancer.

Comparison of Quality of Life in Oral Cancer Patients following Surgery vs Radiotherapy

Background: Oral cancer being one of the most common malignancies in the low-income group in India. It usually presents in an advanced stage limiting treatment options. The mainstays of treatment being surgery and radiotherapy both being lifestyle changing procedures. Aims and objectives: The purpose of this study is to evaluate the quality of life for oral cancer survivors after surgery in comparison with radiotherapy using ICF questionnaire Materials and methods: Oral cancer patients who underwent surgery (25 patients) and Radiotherapy (25 patients) in Stanley medical college for stage 1 and stage 2 lesions of oral carcinoma for past 3 Years (2013-2015) were enrolled. Results: The study showed that surgery as primary therapy provided a better quality of life than radiotherapy alone in the treatment of oral cancer patients. Conclusion: After comparing the results primary surgery for oral malignancy seems to be the treatment of choice as long as the tumor is amenable to surgical resection. Radiotherapy though resulting in a lower quality of life is very efficacious for unresectable tumors.

Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report

Squamous cell carcinoma of the buccal mucosa has an aggressive nature, as it grows rapidly and penetrates well with a high recurrence rate. If cancers originating from the buccal mucosa invade adjacent anatomical structures, surgical tumor resection becomes more challenging, thus raising specific considerations for reconstruction relative to the extent of resection. The present case describes the surgical management of a 58-year-old man who presented with persistent ulceration of the mucosal membrane and a mouth-opening limitation of 11 mm. Diagnostic imaging revealed a buccal mucosa tumor that had invaded the retroantral space upward with involvement of the anterior border of the masseter muscle by the lateral part of the tumor. In this report, we present the surgical approach we used to access the masticator space behind the maxillary sinus and discuss how to manage possible damage to Stensen's duct during resection of buccal mucosa tumors.

Does the use of induction chemotherapy in oral cavity cancer compromise subsequent loco‑regional treatment delivery: Results from a matched pair analysis.

BACKGROUND: Neoadjuvant chemotherapy is being increasingly used in patients with unresectable oral cavity cancers to make them resectable. However, its impact on locoregional treatment delivery in such setting remains poorly studied. AIMS: To evaluate the impact of neoadjuvant chemotherapy on delivery of further locoregional treatment. SETTINGS AND DESIGN: Mono institutional retrospective audit of patients with oral cavity squamous cell cancers treated with neoadjuvant triplet chemotherapy in India. MATERIALS AND METHODS: Patients receiving neoadjuvant chemotherapy (n = 14) from May 2012 to April 2014 were matched 1:2 to patients undergoing upfront surgery (n = 28) based on age (>60 or 60 and less), gender (male or female) and subsite site (tongue and floor of mouth or buccoalveolar complex). Data regarding factors related to the delivery of locoregional treatment and toxicities were compiled. STATISTICAL ANALYSIS: Descriptive analysis in the form of median (range) for continuous variables and frequencies for categorical variables. RESULTS: Patients undergoing neoadjuvant chemotherapy required more extensive resections and had greater operative time (460 vs. 415 min, P < 0.001). A greater incidence of locoregional wound complications was seen as a consequence (57.1% vs. 14.3%, P, 0.01). However, toxicities during radiotherapy were not substantially different between the two groups and compliance to radiation was also similar. Total package time of 100 days or less, was maintained in 90% of patients in both groups. CONCLUSIONS: Delivery of neoadjuvant chemotherapy does not impair the ability to deliver locoregional treatment.

Selective Neck Dissection for Clinically Node-Positive Oral Cavity Squamous Cell Carcinoma

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.

Sentinel Lymph Node Biopsy in the Oral Cavity Cancer / 한양의대학술지

Elective neck dissection for the clinically node-negative neck is targeted to diagnose and eradicate the occult lymph node metastasis. However, this elective neck dissection gives unnecessary risk of complication and morbidity. Therefore, the extent of the elective neck dissection tends to be reduced to minimize the postoperative morbidity. The sentinel lymph node biopsy has been developed for this purpose. Sentinel lymph node is the first lymph node that gets lymphatic drainage from the tumor. Evaluation of this sentinel lymph node enables the prediction of the presence of occult lymph node metastasis. If the biopsy of the sentinel lymph node shows no metastasis, additional neck dissection can be avoided, which reduces the postoperative morbidity. There have been clinical studies on the sentinel lymph node biopsy for the head and neck squamous cell carcinoma, in which the diagnostic accuracy has been reported to be 95-100%. We started sentinel lymph node biopsy for the clinically node-negative, early-staged oral cavity cancer in December 2002. From 2002 to 2004, we evaluated its diagnostic accuracy. The positive predictive value and the negative predictive value were 100% and 98.5%, respectively. We currently determine the elective neck dissection according to the result of the sentinel lymph node biopsy.

The Prognostic Value of DNA Flow Cytometry in Patients with Early Primary Oral Cavity and Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUNDS AND OBJECTIVE: It has been known that tumor size, regional neck metastasis state and tumor thickness are the prognostic factors of oral cavity or oropharyngeal cancer. Additionally, DNA flow cytometry has also been reported to be one of the pronosic factors. We would like to evaluate the prognostic value of DNA flow cytometry in early oral cavity or oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS: We analyzed the relation between tumor thickness or neck metastasis and survival rate in 59 patients with early oral cavity or oropharyngeal cancer. Among those patients, DNA flow cytometry was performed in 28 cases and the prognostic value of the parameters of DNA flow cytometry was analyzed. RESULTS: Overall, a 2-year survival rate of the patients was 90.1%. Neither tumor thickness nor neck metastasis state was related to the overall survival rate. Tumor thickness was not related to neck metastasis state, either. Of the parameters of the DNA flow cytometry, only the S phase fraction of aneuploidy was related to the overall survival rate (p=0.0288). Also the total proportion of aneuploidy was weakly related to the state of neck metastasis (p=0.0518). CONCLUSION: These results indicate that DNA flow cytometry can be used as a good complementary factor for predicting the overall survival or neck metastasis in patients with early primary oral cavity or oropharyngeal squamous cell carcinoma.

Surgical Approach to the Oral Cavity: Techniques, Advantages and Disadvantages of Pull Through Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pull-through approach is one of the surgical approaches for oral cavity cancer, but the reports on its surgical experiences, indications, advantages and disadvantages are lacking. PATIENTS AND METHODS: Fourteen patients of oral cavity and base of tongue cancer who had been treated with the pull-through approach at Severance Hospital from 1994 to 2000 were evaluated retrospectively using their surgical records and pathological reports. All patients had excision of primary tumor and bilateral neck dissection. RESULTS: Total glossectomy was performed with the pull-through approach in four cases of oral cavity or base of tongue cancer. Partial glossectomy or excision of floor of mouth was done with this approach in ten cases of oral cavity cancer. In three patients, partial mandibulectomy was combined with primary extirpation without lip-splitting incision. In all but one case, primary tumor and neck specimen could be removed en bloc. Surgical margins were negative in all cases. Postoperative cosmetic results were satisfactory. CONCLUSIONS: The pull-through approach is one of the useful surgical approach to oral cavity cancer. Especially, the pull-through excision is the choice of approach for total glossectomy. This approach is indicated in most of the oral cavity and the floor of mouth carcinoma with anterior location. It is contraindicated in patients with tumor extended to posterior part of tongue or oropharynx. En bloc excision of intraoral tumor and neck nodes without splitting lower lip or mandible is the major advantage of this approach.

Mandibular Lingual Releasing Approach to Oral and OropharyngealCarcinoma and Parapharyngeal Space Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objectives of treating oral cavity and oropharyngeal cancer are complete removal of tumor, restoration of function and aesthetics, and such treatments require adequate exposure for direct visual and bimanual examination. For posterior oral cavity and oropharynx, the standard approach had been the composite resection. This approach requires mandibulectomy and lip-splitting incision, and thus, complications of mandibulectomy can not be avoided. There is no standard approach for parapharyngeal space tumors due to limited exposure, but most authors have agreed that the best approach is the external approach with or without mandibulotomy. Mandibular lingual releasing approach (MLRA) to oral cavity, oropharynx and parapharyngeal space provides excellent visualization for resection of tumors without lip-splitting, mandibulotomy, nor mandibulectomy. We analyzed the outcome and advantage of MLRA. MATERIALS AND METHODS: We used MLRA to treat 7 patients who had oral cavity or oropharyngeal cancers and one who had parapharyngeal tumor. RESULTS: All tumors could be removed by MLRA. Postoperative complications were wound infection, orocutaneous fistula, and mouth floor wound disruption. But, permanent deficit and complications of lip-splitting, mandibulotomy, or mandibulectomy did not occured. CONCLUSION: The MLRA provides excellent exposure of oral cavity, oropharynx and parapharyngeal space and excellent cosmetic and functional results. It canbe concluded that the MLRA is an excellent approach for tumors of oral cavity, oropharynx and parapharyngeal space.

Radiotherapy for Oral Cavity Cancer / 대한치료방사선과학회지

Eighty five patients of oral cavity cancer, treated with radiation at the Department of Therapeutic Radiology, Korea Cancer Center Hospital, during the period from March 1985 to September 1990 were analyzed retrospectively. Among 85 patients, 37 patients were treated with radiation only and 48 patients were treated with radiation following surgery And 70 patients received external irradiation only by 60Co with or without electron, the others were 7 patients for external irradiation plus interstitial implantation and 8 patients for external irradiation plus oral cone electron therapy. Primary sites were mobile tongue for 40 patients, mouth floor for 17 patients, palate for 12 patients, gingiva including retromolar trigone for 10 patients, buccal mucosa for 5 patients, and lip for 1 patient. According to pathologic classification, squamous cell carcinoma was the most common (77 patients). According to AJC TNM stage, stage I + II were 28 patients and stage III+IV were 57 patients. Acturial overall survival rate at 3 years was 43.9%, 3 year survival rates were 60.9% for stage I + II, and 23.l% for stage III+IV, respectively. As a prognostic factor, primary T stage was a significant factor (p<0.01). The others, age, location, lymph node metastasis, surgery, radiation dose, and cell differentiation were not statistically significant. Among those factors, radiation plus surgery was more effective than radiation only in T3+T4 or in any N stage although it was not statistically sufficient(p<0.1). From those results, it was conclusive that definitive radiotherapy was more effective than surgery especially in the view of pertainig of anatomical integrity and function in early stage, and radiation plus surgery was considered to be better therapeutic tool in advanced stage.