Treatment algorithm for Oral CancerCommissure InvolvementPoorly differ - PDF document

1 Treatment algorithm for Oral CancerCommissure InvolvementPoorly differentiated+ve marginPerineural infiltration L ip cancer Staging evaluationCT scan for T3/T4 to assess nodalspread/bone invasion T1 : Early lesions T2: Moderately advancedlesions (2-4 cm) T3 Locally advanced�lesions (4 cm) T4a T4b yes no Surgery: If Cosmetic & functional out come is Surgery Oral Cone/Ext -RT-Surgery: If Cosmetic & functional out come is favourable -RT –Salvage surgery-Surgery: If Cosmetic & functional out come is favoura�ble PORT.?????????????????????????????????????????????????????????????????????? Palliative RTClinical Trial 2 +ve marginPerineural infiltration F loor of mouth cancer Staging evaluationCT scan forall T3/T4 to assess nodalMRI optional Ta spread/bone invasion T1 : Early lesions(

T1 and superficial T2) T2: Moderately advanced(large T2 and endophytic T3) T3 Locally advanced�lesions (4 cm) T4a T4b Operable Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy Oral Cone/Ext -Close/involved margins-perineural/lymphatic -neck involvedwith multiple nodes orextracapsular extension Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery* Surgery*??????????????????????????????????????????????????????????????????????????????????????????????????????? ??????? ????? concomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapConcomitant Chemothera Symptomatic Clinical Trial Surgery* Radiotherapy+/-Concomitant Chemotherapy 3 O ral tonguecancer Staging evaluation T1 : Early lesions(T1 and supe

rficial T2) T2: Moderately advanced T3 Locally advanced�lesions (4 cm) T4a T4b Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy ISBT/Intra Oral Cone/Ext RT +/-concomitant CT Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery * Surgery�*: 1cms margin preferable. ??????????????????????????????????????????????????????????????????????????????????????????????????????? ???????????? concomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapyConcomitant Chemotherapy Symptomatic & Clinical Trial Surgery* Radiotherapy+/-Concomitant Chemotherapy Or Palliative RT RT * -Exophytic lesion* Close involved multiple positive vascular space extracapsularextension/perine ural Operable 4 Buccal Mucosa canc

er (Includes Lip Mucosa)Staging evaluationX ray mandible T1 : Early lesions(T1 and superficial T2) T2: Moderately advanced T3 Locally advanced�lesions (4 cm) T4a T4b Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy ISBT/Intra Oral Cone/Ext RT +/-concomitant CT Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery* Surgery�*: 1cms margin preferable. ?????????????????????????????????????????????????????????????????????????????????????Tumor �thickness 6 mm, Depth of ?????????????????????????????????????????????????????????????????????????????????????????????????? concomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapyConcomitant Chemotherapy Symptomatic & Clinical Trial Surgery* Ra

diotherapy+/-Concomitant Chemotherapy RT*: ISBT. Ext+Brachy, Ext RT Commisure Free.Ulacerative, Close involved multiple positive vascular space extracapsularextension/peri- neural Operable -Exophytic 5 GINGIVA cancer Upper Gingiva Lower Gingiva Staging evaluationX ray mandible T1: Early lesions(T1 and superficial T2) T2: Moderately advanced T3 Locally advanced�lesions (4 cm) T4a T4b Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy ISBT/Intra Oral Cone/Ext RT +/-concomitant CT Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery*: Surgery�*: 1cms margin preferable. Include periostium Upper Alveolus: Partial / Total maxillectomyLower Alveolus: rim resection/ intro oral excision????????????????????????????????????????????

?????????????????????????????????????????????? ???????? concomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapyConcomitant Chemotherapy Clinical Trial Surgery* Radiotherapy+/-Concomitant Chemotherapy Ext+IOCone RT, Ext RT Close involved multiple positive vascular space extracapsularextension /peri- neural Operable Extension to Hard palate or Exophytic 6 Retromolar trigone cancer Staging evaluation T1 : Early lesions(T1 and superficial T2) T2: Moderately advanced T3 Locally advanced�lesions (4 cm) T4a T4b Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy Cone/Ext RT Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery*: Perineural Surgery*: Include periostium or ????????????????????????????

????????????????????? ???????? concomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapyConcomitant Chemotherapy Symptomatic & Clinical Trial Surgery* Radiotherapy+/-Concomitant Chemotherapy Ext+IOCone RT, Ext RT Operable Superficial ,Exophytic lesion, Involvement of the tonsillar pillar, softpalate, or buccal 7 Hard Palate cancer Staging evaluation T1 : Early lesions(T1 and superficial T2) T2: Moderately advanced T3 Locally advanced�lesions (4 cm) T4a T4b Inoperable Post Operative Radiotherapy+/_ Concomitant Chemotherapy PO RT: Intra Oral Cone/Ext RT Post Operative Radiotherapy+/_ Concomitant Chemotherapy Palliative RTClinical Trial Surgery*: Perineural Surgery*: Include periostium or ?????????????????????????????????????????????????? ???????? c

oncomitant CT Complete Response Partial response No response/ Ca/Progressive Surgery* RadiotherapyConcomitant Chemotherapy Symptomatic & Clinical Trial Surgery* Radiotherapy+/-Concomitant Chemotherapy Ext+IOCone RT, Ext RT Operable Superficial ,Exophytic lesion, Involvement of the tonsillar pillar, soft 8 Oral cancer : General Treatment principles Preferred Primary Treatment Modality T1 & T2 N0 Surgery or RT T3 & T4 A Any N Surgery + PORT T4b Palliative RT/CT/Clinical Trial Primary RT is prefered in Primary RT is prefered for early T1/T2 patients ProfessionAngle of the mouth Co-morbid conditons FOMIOCRT TongueExt RT + Brachy BMExt RT + IOCRT Post O perative radiotherapyis indicated in :- N0 Clinically -N+ pathologically perineural invasion21 -50% 12 -19% Hard palate 0 -10% 25 -54% Retro Molar Trigone