For patients with oral cavity squamous cell carcinoma (OSCC), curative-intent surgery is not always possible. Tumor characteristics, patient-related factors such as old age, poor performance status, or medical comorbidities carrying high operative risk, as well as patient refusal, can each make surgery an unsuitable path. A structured, evidence-based approach exists for these situations.
This protocol covers OSCC where upfront surgery is not feasible due to one or more of the following:
When surgery is not an option, the evidence supports a definitive radiation-based strategy as the primary management approach. The full protocol details the applicable regimen options and the clinical decision points that determine which path is appropriate for a given patient.
DOI: 10.1200/EDBK_389810
In a substantial proportion of patients with OSCC, up-front curative-intent surgery may not be possible for one or more of the following reasons: (1) cancer-related factors (eg, unresectable tumor), (2) patient-related factors (eg, patient refusal to undergo surgery or those with old age, poor performance status [PS], or medical comorbidities with high operative risk), (3) treatment-related factors (eg, extent of curative-intent surgery will result in unacceptable local morbidity and unsatisfactory functional outcomes), and (4) health care system–related factors (eg, limited health care insurance or unavailable access to proper operative facilities and resources).
Definitive RT/CRT for OSCC could be a reasonable alternative management strategy to primary surgery when it is not feasible in view of patient, tumor, treatment, or health care system–related factors.
High-dose radiation (with concurrent chemotherapy) for OCC could be a reasonable alternative management strategy to primary surgery when it is not feasible and also for patients with early recurrence before the planned postoperative radiation.
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