Role of structures in the masticator space in selecting patients with resectable T4b oral cancer: findings from a survival analysis

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

“…New surgical techniques such as endoscopicassisted access to the masticator space have allowed for resection of cT4b oral cavity SCC. 22,32,38,40,71,75,76 Tumors infiltrating the pterygoid plates and dura may be resected with negative margins by implementing combined open and endoscopic approaches and advanced reconstructive techniques. 77 Surgical resection + adjuvant therapy has been associated with higher OS than definitive RT or CRT in cT4b oral cavity SCC, sinonasal SCC, and head and neck AdCC.…”

“…6 Studies of cT4b oral cavity and sinonasal SCC report 2-year OS that ranges from 25% to 60% depending on treatment intent and modality. 22,32,33,[35][36][37] cT4b AdCC, which has a predilection for the major salivary glands, exhibits more indolent behavior than cT4b SCC; 3-year OS ranges from 70% to 80% depending on definitive treatment modality. 34 Fiveyear OS in our cohort was 44.8%, aligning well with existing literature.…”

“…Most patients with cT4b MSGC therefore undergo definitive CRT, experimental hormonal or immunotherapies, or palliative care 23‐31 . However, retrospective studies of cT4b head and neck squamous cell carcinoma (HNSCC) suggest that surgical resection may be undergone safely and with acceptable morbidity in some cT4b tumors which are closer to cT4a in extent and outcome 22,32‐40 . Considering that MSGC is less sensitive to chemotherapy than HNSCC, exploring the utility of surgical resection in cT4b MSGC could benefit certain patients.…”

“…[23][24][25][26][27][28][29][30][31] However, retrospective studies of cT4b head and neck squamous cell carcinoma (HNSCC) suggest that surgical resection may be undergone safely and with acceptable morbidity in some cT4b tumors which are closer to cT4a in extent and outcome. 22,[32][33][34][35][36][37][38][39][40] Considering that MSGC is less sensitive to chemotherapy than HNSCC, exploring the utility of surgical resection in cT4b MSGC could benefit certain patients. Our study of the National Cancer Database (NCDB) investigates surgical resection and associated survival outcomes in cT4b MSGC.…”

Achieving negative resection margins in oral cavity cancer with masticator space involvement—Is it feasible? International collaborative study

“…The original publication by Liao et al 6 proposed the division of the masticatory space into infra‐notch and supra‐notch compartments, and doing so has demonstrated that infra‐notch patients performed significantly better compared to their supra‐notch counterparts (5‐year overall survival of 55.3 vs. 14.3%, respectively). A recent study by Kumar et al 16 demonstrated that patients with involvement of three or fewer masticatory space structures (i.e., out of four muscles of mastication, the ascending ramus of mandible, and the pterygoid plates) have a better prognosis compared to patients with more than three structures being involved in the masticator space. Another important factor in prognostication found in our study was that adjuvant treatment did not significantly alter prognosis in patients with positive margins.…”