From the Guidelines
For patients with resected, high-risk, locally advanced oral glossus squamous cell carcinoma who are ineligible for cisplatin, radiation therapy (RT) alone remains a reasonable and acceptable standard of care option due to the lack of clinical data showing improved efficacy with alternative adjuvant treatments. The management of such patients is challenging due to the scarcity of clinical data supporting specific adjuvant treatment options 1. Several factors contribute to the recurrence of oral glossus squamous cell carcinoma, including initial tumor characteristics such as advanced stage at diagnosis, positive surgical margins, perineural invasion, lymphovascular invasion, and extracapsular extension.
Key Considerations
- Tobacco use and alcohol consumption are significant risk factors for recurrence 1.
- Human papillomavirus (HPV) infection, particularly HPV-16, may contribute to recurrence in some cases.
- Poor oral hygiene and chronic inflammation can provide an environment conducive to cancer recurrence.
- Inadequate initial treatment can leave patients vulnerable to recurrence.
- Genetic factors, including mutations in TP53, NOTCH1, and CDKN2A genes, can drive aggressive disease behavior.
Adjuvant Treatment Options
- The NCCN Guidelines list docetaxel plus cetuximab plus RT as a potential treatment option for adjuvant treatment in patients with positive margins and/or extranodal extension who are ineligible for cisplatin, with level of evidence 2B 1.
- A recent phase 3 study explored docetaxel plus RT in patients with locally advanced squamous cell carcinoma of the head and neck who were ineligible to receive cisplatin, showing improved disease-free survival (DFS) and overall survival (OS) rates compared to RT alone 1.
- However, a subgroup analysis of the adjuvant population alone showed no significant improvements in DFS and OS with the addition of docetaxel to RT 1.
Clinical Implications
- Given the lack of clinical data showing improved efficacy in this population, RT alone remains a reasonable and acceptable standard of care option 1.
- Regular follow-up with comprehensive oral examinations and imaging studies is essential for early detection of recurrence, as prompt intervention offers the best chance for successful management.
From the Research
Factor Recurrence Oral Glossus Squamous Cell Carcinoma
- The recurrence of oral glossus squamous cell carcinoma is a significant concern, with a high rate of mortality, recurrence, and metastasis 2.
- Factors associated with worse overall survival (OS) and disease-free survival (DFS) include higher pathologic T stage, lymph node positivity, and disease recurrence 3.
- The rate of secondary tumor formation is 3-7% yearly, which can lead to disease recurrence 4.
- Treatment outcomes for squamous cell carcinoma of the oral cavity in young adults are similar to those in older adults, with a 5-year overall survival rate of 78.1% and a 10-year overall survival rate of 76.9% 3.
- Immunotherapy is a crucial aspect of cancer treatment, especially in oral cancers, and its effectiveness lies in targeting immune checkpoints, such as PD-1 and CTLA-4 inhibitors, as well as monoclonal antibodies like pembrolizumab and cetuximab 5.
- Pharmacological treatment options for oral cavity squamous cell carcinoma include surgery, radiotherapy, and chemotherapy, with an emphasis on drugs that can enhance the efficacy of anticancer drugs, such as cisplatin, paclitaxel, and EGFR antagonists 2.
- Radiotherapy and concomitant intraarterial cisplatin (RADPLAT) have been shown to result in excellent local-regional control and survival in patients with advanced squamous cell carcinomas of the head and neck 6.