Outcome of compartment resection of locally advanced oral cancers extending to infratemporal fossa: a tertiary rural hospital experience

Abstract

Locally advanced oral cancers extending to infratemporal fossa (ITF) are a challenge to head and neck surgeons. These tumors are classified as T whenever the masticator space (MS), pterygoid muscles (PM), and pterygoid plates (PP) are involved according to AJCC classification. Until recently, these tumors were considered inoperable and treated only with palliative intent. However, a few studies in the last decade showed that many of these tumors could be resected with a reasonably favorable prognosis by compartment resection of ITF, particularly when the tumor was below sigmoid notch of mandible. A few studies attempted to downstage these tumors by neo-adjuvant chemotherapy before attempting resection. Oral Squamous cell carcinoma has a high prevalence in South India. Majority of these patients are females addicted to tobacco quid chewing and present with locally advanced disease. In this retrospective analysis, we evaluated the outcome of treatment of oral squamous cell carcinoma extending to ITF and staged T in 52 patients. All patients underwent Composite resection including compartment resection of ITF followed by adjuvant treatment. 20 patients had received neo-adjuvant chemotherapy. Pectoralis major myocutaneous flap was the mainstay of reconstruction. After mean follow-up of 2 years, 31 patients are alive and disease free. 14 patients had local recurrence in ITF and 2 patients had recurred in cervical nodes. 8 patients died due to disease and 6 are on palliative care. Neo-adjuvant chemotherapy did not benefit the outcome. Close margins of resection, extra nodal spread from lymph nodes and supra notch and involvement of posterior part of ITF were factors which predisposed to recurrence.

Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

“…Up‐front surgery might not be considered for T4b tumors of the oral cavity due to the difficulty in obtaining adequate margins. However, new surgical techniques, such as endoscopic‐assisted access to the masticator space, and improved reconstruction techniques have allowed for growing evidence that some of these lesions may in fact be amenable to surgical extirpation, with a reasonable possibility of achieving negative margins and improved functional outcomes 3–7,10,14 . In this study, we examined all cases of T4b OCSCC in the NCDB and investigated the outcome of different treatment approaches.…”

“…2 While these tumors have classically been considered unresectable due to the difficulty in obtaining negative margins, several single-institution studies have described a role for up-front curative intent surgery. 3-7…”

“…4 Two subsequent trials in India reported that radical en bloc resection of tumors that invade the masticator space can be achieved with acceptable margin control and limited morbidity. 6,7 A single-institution study of 25 patients recently suggested a benefit of adjuvant chemoradiotherapy (CRT) to primary surgery and a disease-specific survival of 63.2% at 2 years. 9 With more advanced techniques being developed for surgical access to the masticator space, 10,11 it seems justified to reassess the very locally advanced classification of these lesions (unresectable in the prior editions).…”

ALG3 contributes to the malignant properties of OSCC cells by regulating CDK‐Cyclin pathway

“…More than 500,000 individuals are diagnosed with OSCC each year in the world (Fan et al., 2011). Despite the relatively lower metastatic rate (20%), OSCC grows rapidly and typically invades nearby bone and tissue, in addition to owning an extremely high frequency of local recurrence (Mohiyuddin et al., 2018). The major treatments for early OSCC include surgery and radiation therapy alone or accompanied by chemotherapy (Zhou et al., 2019).…”

ALG3 Contributes to the Malignant Biological Properties of Oral Squamous Cell Carcinoma Cells Through Regulating CDK-Cyclin Pathway

“…More than 500,000 individuals are diagnosed with OSCC each year in the world [2]. Despite the relatively lower metastatic rate (20%), OSCC grows rapidly and typically invades nearby bone and tissue, in addition to owning an extremely high frequency of local recurrence [3]. The major treatments for early OSCC includes surgery and radiation therapy alone or accompanied with chemotherapy [4].…”