title: Impact of treatment sequence of multimodal therapy for advanced oral cavity cancer with mandible invasion.
abstract: OBJECTIVE
  To determine the effect of treatment sequence of multimodal therapy for clinically advanced squamous cell carcinoma (SCC) of the oral cavity (OC) with mandible invasion.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  University-based, tertiary care hospitals.
  
  
  METHODS
  The authors retrospectively analyzed 70 patients presenting between January 2000 and January 2010 with newly diagnosed, previously untreated SCC of the OC with mandible invasion that we deemed resectable (stages IVa, b). Patients with evidence of distant metastases or a second primary malignancy were excluded. All patients were presented at a multidisciplinary tumor board for prospective planning of trimodality therapy (surgery, radiation therapy, chemotherapy). When performed, surgery included segmental mandibulectomy. Radiotherapy was delivered using standard intensity-modulated radiation therapy technique. Study patients were divided into 2 groups: group 1 received induction chemotherapy and/or concurrent chemoradiation followed by surgery, and group 2 was treated with primary resection followed by chemoradiation.
  
  
  METHODS
  Progression-free survival (PFS).
  
  
  RESULTS
  Eighteen patients (26%) comprised group 1, and 52 patients (74%) comprised group 2. The groups were matched in oral cavity subsite, tumor differentiation, tumor characteristics of aggressiveness (perineural and lymphovascular invasion), extent of mandible invasion, and cervical node status. The 5-year PFS for group 1 (33.3%) was not significantly different from that for group 2 (32.3%; P = .643).
  
  
  CONCLUSIONS
  Advanced OC cancer with mandible invasion is an ominous disease. Although treatment must be individualized, our data suggest no clear advantage to any specific sequence of multimodality therapy affecting PFS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Head and Neck Cancer Disease Oriented Team, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9035, USA. larry.myers@utsouthwestern.edu
authors.forename: Larry L
authors.initials: LL
authors.lastname: Myers
authors.forename: Baran D
authors.initials: BD
authors.lastname: Sumer
authors.forename: John M
authors.initials: JM
authors.lastname: Truelson
authors.forename: Lucien
authors.initials: L
authors.lastname: Nedzi
authors.forename: Steve
authors.initials: S
authors.lastname: Perkins
authors.forename: Randall S
authors.initials: RS
authors.lastname: Hughes
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008339:Mandibular Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D013515:Surgery, Oral / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome