Clinical Scenario

Treatment of Locally Advanced Oral Cavity Squamous Cell Carcinoma Requiring Mandibulectomy When No Mandibular Bone Erosion Is Present

This protocol addresses a specific and carefully defined patient population: those with locally advanced oral cavity squamous cell carcinoma (OSCC) where the tumor burden is sufficient to indicate mandibulectomy, yet neither clinical examination nor radiographic imaging reveals mandibular bone erosion. This distinction opens the door to a mandibular-preserving strategy not available once bone invasion has occurred.

Clinical Situation

The patient has locally advanced OSCC of a severity that would normally necessitate mandibulectomy. Critically, there is no clinical or radiographic evidence of mandibular bone erosion. In carefully selected cases, this combination of factors makes organ-preservation approaches a meaningful consideration alongside standard resection.

Treatment Goal

The primary objective is tumor reduction sufficient to permit mandibular preservation — achieving disease control while avoiding jaw resection and its lasting functional and cosmetic consequences, without compromising oncologic outcomes.

Approach (Partial Overview)

The strategy centres on induction chemotherapy administered before surgery. Response to this pre-operative treatment informs whether mandibular-sparing surgery can proceed. Adjuvant treatment follows thereafter.

The complete regimen — including drug selection, scheduling, eligibility requirements, and the post-induction decision algorithm — is contained in the full structured protocol below.

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References

DOI: 10.1200/EDBK_389810

In patients with locally advanced OSCC that would necessitate mandibulectomy, but no clinical and radiographic evidence of mandibular erosion, induction chemotherapy with three cycles of docetaxel + cisplatin + FU followed by an attempt at mandibular preservation surgery (possibly on the basis of the postinduction chemotherapy tumor volume) and adjuvant concurrent chemoradiotherapy may be a potential strategy for organ preservation, without compromising oncologic survival outcomes in carefully selected cases.

However, it can potentially be used in the neoadjuvant setting for patients with advanced-stage disease aiming for tumor reduction that may permit better functional and cosmetic outcomes (eg, mandibular preservation), while maintaining similar oncologic outcomes.

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