Preoperative chemoradiotherapy in the management of oral cancer: a review. J Craniomaxillofac Surg

Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, AKH, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Journal of Cranio-Maxillofacial Surgery (Impact Factor: 2.93). 04/2008; 36(2):75-88. DOI: 10.1016/j.jcms.2007.06.007
Source: PubMed


Multi-modality treatment concepts involving preoperative radiotherapy (RT) or chemoradiotherapy (CRT) and subsequent radical resection are used much less frequently than postoperative treatment for oral and oropharyngeal squamous cell carcinomas. In some centres, however, the preoperative approach has been established for several years.
The present review is a compilation of the existing evidence on this subject.
In a literature-based meta-analysis, the survival data of 1927 patients from 32 eligible publications were analysed.
The calculated survival rates of documented patients show remarkably good results with preoperative CRT and radical surgery. However, the findings of this analysis are based on data with a large proportion of studies using consecutive patient series.
Hard evidence providing sufficient data from prospective randomised studies is as yet missing for preoperative CRT. Prospective randomised studies are mandatory in this area.

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    • "This enables noninvasive identification of muscle fibrosis, inflammation, and denervation, all markers of muscle damage after radiotherapy [7,8,10]. Although radiotherapy has become essential in the treatment of head and neck cancers [19], damage to adjacent non-cancerous tissues is frequent and may appear immediately or years after irradiation [10,20]. Radiation-induced damage to vascular and neural structures and slowly proliferating connective tissue cells explains the complications and side effects that alter bone, cartilage and muscular tissues [10]. "
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    ABSTRACT: Radiotherapy to the head and neck regions can result in serious consequences to the temporomandibular joint (TMJ) and chewing muscles. Magnetic resonance imaging (MRI) demonstrates soft-tissue alterations after radiotherapy, such as morphology and signal intensity. The purpose of this review is to critically and systematically analyse the available evidence regarding the masticatory muscles alterations, as demonstrated on MRI, after radiotherapy for head and neck cancer. Electronic search of MEDLINE, EMBASE, EBM reviews and Scopus. Reports of any study design investigating radiation-induced changes in masticatory muscles after radiotherapy in patients with head and neck cancer were included. RESULTS AND SYNTHESIS METHODS: An electronic database search resulted in 162 papers. Sixteen papers were initially selected as potentially relevant studies; however, only four papers satisfied all inclusion criteria. The included papers focused on the MRI appearance of masticatory muscles following radiotherapy protocol. Two papers reported outcome based on retrospective clinical and imaging records, whereas the remaining two papers were case reports. Irradiated muscles frequently show diffuse increase in T2 signal and post-gadolinium enhancement post-irradiation. Also, muscle size changes were reported based on subjective comparison with the contralateral side. The quality of all included papers was considered poor with high risk of bias. There is no evidence that MRI interpretations indicate specific radiation-induced changes in masticatory muscles. There is a clear need for a cohort study comparing patients with pre- and post-radiotherapy MRI.
    Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 03/2013; 42(1):26. DOI:10.1186/1916-0216-42-26 · 0.89 Impact Factor
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    • "Most studies in the literature have used 40 or 50 Gy for preoperative radiotherapy, and cisplatin is often used as the radiosensitizing agent [4, 5, 7]. In a large study by Klug et al. [8] that summarized the results of preoperative chemoradiotherapy for oral and oropharyngeal cancer, the 5-year survival rate determined by meta-analysis of 32 studies (1,927 patients) was a remarkably good 62.6 %. Kirita et al. [9] reported obtaining a clinical response rate of 92.8 %, and a 5-year overall actuarial survival rate of 79.3 %, by treating advanced OSCC with preoperative cisplatin-based intravenous chemotherapy and concurrent radiotherapy at a total dose of 40 Gy. "
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    ABSTRACT: Purpose We evaluated whether preoperative chemotherapy with S-1 and concurrent radiotherapy is feasible and efficacious in the treatment of advanced oral squamous cell carcinoma. Methods Participants comprised 39 patients with oral carcinoma (stage III, n = 15; stage IVA, n = 24). All patients received a total radiation dose of 40 Gy, in once-daily 2-Gy fractions, and received S-1 at 65 mg/m2/day for 5 consecutive days, over 4 consecutive weeks with concurrent radiotherapy. Results Hematological toxicity was mild and reversible. The most common non-hematological toxicity was grade 3 mucositis, but this was transient and tolerable. Radical surgery was performed for 37 patients, with the remaining 2 patients declining the surgery. Postoperatively, local failure developed in 1 patient, and neck failure in 2 patients. Distant metastases were identified in 4 patients. At a median follow-up of 38.0 months (range 23–88 months), locoregional control, disease-specific survival, and overall survival rates at 3 years were 91.5, 83.8, and 83.8 %, respectively. Conclusion Concurrent administration of S-1 and radiotherapy combined with surgery offers a well-tolerated method of successfully treating advanced oral squamous cell carcinoma. The locoregional control rate remains high even at 3 years of follow-up, and no serious adverse effects have been encountered.
    Cancer Chemotherapy and Pharmacology 02/2013; 71(4). DOI:10.1007/s00280-013-2101-5 · 2.77 Impact Factor
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    • "Nevertheless, for about 20 years, preoperative therapy concepts have been established as the standard approach in some centers. Klug et al. summarized the results of the preoperative chemoradiotherapy for oral cancer [1]. He reported that 5-year survival rate determined by the meta-analysis of the 32 studies (1927 patients) was 62.6%, appearing to be remarkably good. "
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    ABSTRACT: This study was conducted to identify a recommended dose for S-1, used in combination with 40-Gy radiation. Thirty patients, 15 each with stage III and IVA oral carcinoma, were enrolled. All patients received a total dose of 40-Gy. For the S-1 treatment, patients were given either the standard Japanese dose, calculated according to body surface area, or a reduced dose. Groups consisting of at least three patients were given S-1 according to one of 8 regimens. Hematologic toxicity was mild and reversible. The most common nonhematologic toxicity was mucositis. At level 8 that was the standard S-1 dose for 5 days per week for 4 weeks, dose-limiting toxicity was observed when 2 patients had grade 4 mucositis. This level was thus deemed the maximum tolerated dose for the regimen. The recommended dose of S-1 with concurrent radiotherapy was the reduced dose of S-1 given for 5 days per week, for 4 consecutive weeks. Preoperative S-1 and concurrent radiotherapy was well tolerate and feasible and warrants a phase II study.
    Journal of Experimental & Clinical Cancer Research 04/2010; 29(1):33. DOI:10.1186/1756-9966-29-33 · 4.43 Impact Factor
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