Conservative treatment in locally advanced oral cavity cancer

This study aimed to review clinical experiences using whole-field simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequential IMRT in postoperative patients with oral cavity cancer (OCC). From November 2006 to December 2014, a total of 182 postoperative patients with OCC who underwent either SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolled retrospectively and matched randomly according to multiple risk factors by a computer. The differences were well balanced after patient matching ( P = .38). The median follow-up time was 65 months. For patients treated with the SIB technique and the sequential technique, the respective mortality rates were 36.8% and 20.0% ( P = .04). The primary recurrence rates were 26.3% and 10.0% ( P = .02), respectively. The respective marginal failure rates were 26.7% and 16.7%. A multivariate logistic regression analysis showed that patients who received the SIB technique had a 2.74 times higher risk of death than those who received the sequential technique (95% confidence interval = 1.10-6.79, P = .03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2 Gy, P = .02) and trachea (4.6 Gy, P = .03) than SIB-IMRT. For patients with locally advanced OCC, postoperative sequential IMRT may overcome an unpredictable geographic miss, potentially with a lower marginal failure rate in the primary area. Patients treated by sequential IMRT show equal overall survival benefits to those treated by SIB-IMRT and a lower mortality rate than those treated by SIB-IMRT. Additionally, a reduced dose to the esophagus and trachea compared to sequential IMRT was noted.

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Phase 2 Trial of Nivolumab, an Anti-PD-1 Monoclonal Antibody, as a Novel Neoadjuvant Pre-surgical Therapy for Locally Advanced Oral Cavity Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.12.295 ◽

2018 ◽

Vol 100 (5) ◽

pp. 1315 ◽

Cited By ~ 1

Author(s):

J. Kaczmar ◽

A. Kompelli ◽

E. Graboyes ◽

J. Hornig ◽

E. Lentsch ◽

...

Keyword(s):

Monoclonal Antibody ◽

Oral Cavity ◽

Surgical Therapy ◽

Oral Cavity Cancer ◽

Locally Advanced ◽

Phase 2 ◽

Phase 2 Trial

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The impact of trans-arterial embolization on the result of chemoradiotherapy in oral cavity cancer

Ear Nose & Throat Journal ◽

10.1177/01455613211054181 ◽

2021 ◽

pp. 014556132110541

Author(s):

Dang Nguyen Van ◽

Quang Le Van ◽

Nhung Nguyen Thi Thu ◽

Giang Bui Van ◽

To Ta Van

Keyword(s):

Oral Cavity ◽

Concurrent Chemoradiotherapy ◽

Oral Cavity Cancer ◽

Locally Advanced ◽

Arterial Embolization ◽

Progression Free Survival ◽

Bleeding Complications ◽

Selective Embolization ◽

Acute Bleeding ◽

The Impact

Objectives: Evaluation of the hemostatic effect of trans-arterial embolization on patients with advanced oral cavity cancer who had bleeding complications while undergoing definitive concurrent chemoradiotherapy (CCRT). Additionally, assess the effect of trans-arterial embolization on treatment response following concurrent chemoradiotherapy, as well as overall survival (OS) and progression-free survival (PFS) in the group of patients following the intervention. Method: From September 2018–June 2021, a retrospective descriptive study was conducted on 16 patients with inoperable, locally advanced oral cavity cancer who received definitive concurrent chemoradiotherapy, experienced acute bleeding complications, and received selective intravascular intervention with various embolization materials at Vietnam National Cancer Hospital. Results: After selective embolization, 16/16 patients ceased bleeding; 1 patient re-bled for the second time after 3 weeks. The average duration of chemoradiotherapy interruption due to intervention was 6.7 days. After CCRT, 15/16 (93.75%) patients achieved a response, with 9/16 (56.25%) patients achieving a complete response. The median OS was 14 months (range, 3–26 months), and the median PFS was 10 months (range, 3–20 months). There were no significant complications, particularly neurological side effects. ConclusionsTumor bleeding is a common and serious complication of CCRT treatment in patients with locally advanced oral cavity cancer. Embolization is a safe and effective method of controlling acute bleeding that has no adverse effect on the outcome of definitive concurrent chemoradiotherapy.

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Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: A retrospective study from rural India

South Asian Journal of Cancer ◽

10.4103/2278-330x.181625 ◽

2016 ◽

Vol 05 (02) ◽

pp. 052-055 ◽

Cited By ~ 6

Author(s):

Avinash Pandey ◽

A. Desai ◽

V. Ostwal ◽

V. Patil ◽

A. Kulkarni ◽

...

Keyword(s):

Oral Cavity ◽

Oral Cavity Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Metronomic Chemotherapy ◽

Tobacco Consumption ◽

Rural India ◽

Rank Test ◽

Factors Affecting ◽

Oral Cavity Carcinoma

Abstract Background: Oral cavity cancer is the most common cancer among rural India. There is a paucity of data for outcomes of operable oral cavity cancer from rural India. Use of maintenance metronomic may delay or avoid relapse. Aim: To evaluate outcomes of operable oral cavity carcinoma and evaluate impact of maintenance metronomic chemotherapy. Objectives: To evaluate disease-free survival (DFS), overall survival (OS), and factors affecting the outcome in operable oral cavity cancer. Materials and Methods: Data of patients diagnosed with oral cavity cancer registered between May 2008 and May 2014 were retrieved. Only those patients with operable oral cavity cancer and upfront definitive surgery were included in the study. Demographic profile, stage, tobacco consumption, adjuvant therapy, and pattern of failure were collected. Kaplan-Meir survival analysis was used to determine DFS and OS. Log-rank test was used to evaluate factors affecting outcome. Results: Median follow-up is 24 months. Out of 335 patients, 225 (67%) had advanced operable cancer with 42/225 (18%) and 183/225 (82%) as Stages III and IVA, respectively. Buccal mucosa was the most common subsite (178/335, 53%) followed by tongue (63/335, 19%). Ninety-two percent patients were addicted to smokeless tobacco, whereas 27% were smokers. Median DFS is 13 months with 2 years relative DFS 32%. Median OS is 30 months, with 2 years OS of 54%. Metronomic adjuvant oral chemotherapy was given in 130/225 (58%); Stage III and IVA patients with median of 14 months (3-18 months). Use of metronomic chemotherapy improved DFS (8 vs. 14 months, P = 0.22) and OS (14 vs. 26 months, P = 0.04). Conclusion: Oral cavity cancer is a major health care problem in rural India. Presentation at advanced stage leads to suboptimal outcomes. Benefit of metronomic maintenance chemotherapy in locally advanced oral cavity needs to be further evaluated prospectively.

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Not So Fast: Deintensification Therapy for Locally Advanced Oral Cavity Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.01.025 ◽

2020 ◽

Vol 106 (5) ◽

pp. 926-927

Author(s):

Darrion L. Mitchell ◽

Steven K. Clinton ◽

Matthew O. Old

Keyword(s):

Oral Cavity ◽

Oral Cavity Cancer ◽

Locally Advanced

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Progressive muscle loss is an independent predictor for survival in locally advanced oral cavity cancer: A longitudinal study

Radiotherapy and Oncology ◽

10.1016/j.radonc.2021.02.014 ◽

2021 ◽

Author(s):

Jie Lee ◽

Shih-Hua Liu ◽

John Chun-Hao Chen ◽

Yi-Shing Leu ◽

Chung-Ji Liu ◽

...

Keyword(s):

Longitudinal Study ◽

Oral Cavity ◽

Oral Cavity Cancer ◽

Independent Predictor ◽

Locally Advanced ◽

Muscle Loss

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Concurrent Chemoradiotherapy Induces Body Composition Changes in Locally Advanced Head and Neck Squamous Cell Carcinoma: Comparison between Oral Cavity and Non-Oral Cavity Cancer

Nutrients ◽

10.3390/nu13092969 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2969

Author(s):

Yu-Ching Lin ◽

Hang Huong Ling ◽

Pei-Hung Chang ◽

Yi-Ping Pan ◽

Cheng-Hsu Wang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Body Composition ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Concurrent Chemoradiotherapy ◽

Oral Cavity Cancer ◽

Locally Advanced ◽

Advanced Head ◽

Treatment Interval

Few prospective cohort trials have evaluated the difference in treatment-interval total body composition (TBC) changes assessed by dual-energy X-ray absorptiometry (DXA) between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC) receiving concurrent chemoradiotherapy (CCRT): oral cavity cancer with adjuvant CCRT (OCC) and non-oral cavity with primary CCRT (NOCC). This study prospectively recruited patients with LAHNSCC. Clinicopathological variables, blood nutritional/inflammatory markers, CCRT-related factors, and TBC data assessed by DXA before and after treatment were collected. Multivariate linear regression analysis identified the factors associated with treatment-interval changes in body composition parameters, including lean body mass (LBM), total fat mass (TFM), and bone mineral content (BMC). A total of 127 patients (OCC (n = 69) and NOCC (n = 58)) were eligible. Body composition parameters were progressively lost during CCRT in both subgroups. Extremities lost more muscle mass than the trunk for LBM, whereas the trunk lost more fat mass than the extremities for TFM. BMC loss preferentially occurred in the trunk region. Different factors were independently correlated with the interval changes of each body composition parameter for both OCC and NOCC subgroups, particularly mean daily calorie intake for LBM and TFM loss, and total lymphocyte count for BMC loss. In conclusion, treatment-interval TBC changes and related contributing factors differ between the OCC and NOCC subgroups.

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