6. QUESTIONS DISCUSSED
Requirement of coronoidectomy along with marginal
mandibulectomy?
How to prevent fracture following marginal
mandibulectomy?
How and when to preserve the lingual nerve during
marginal mandibulectomy?
RMT lesion with no gross bone involvement clinically and
radiologically-choice of mandibulectomy?
Post RT case-How to protect the blood supply of
mandible while raising a cheek flap?
10. QUESTIONS DISCUSSED
How to decide which incision to take?
How to carry out pterygomaxillary disjuntion?
When to remove the inferior turbinate?
Is it possible to place implants immidiately after
maxillectomy?
How to decide the reconstruction?
Difference in treating adenoid cystic carcinoma from
squamous cell carcinoma?
11. Early Oral Cancers:Panel Discussion
1.Importance of depth of invasion
Can be considered in tongue lesions as usually
pre-operative MRI is done.
More important in post-operative setting and used
as factor in pathological classification.
12. 2.Imaging in Early Oral Cancers
Should be considered in majority of cases.
Critical in tongue, gbs lesions.
14. Immunotherapy for Oral Cavity and Oropharyngeal
Cancer
Pembrolizumab (Keytruda) and nivolumab (Opdivo) are
drugs that target PD-1, a protein on T cells in the immune
system.
PD-1 normally helps keep T cells from attacking other cells . By
blocking PD-1, these drugs boost the immune response against
cancer cells. This can shrink some tumors or slow their growth.
Single/double dose:50%-60% success rate.
15. Risk of nodal metastasis after
primary Brachytherapy
•Single instituitional experience of 42 patients.
•Late nodal recurrence after treatment by primary brachytherapy-80%
•Tumor thickness >6mm,risk of recurrence seen to be higher
16. • Brachytherapy is suggested for oral tumors of depth<=1.5cm and at least
5mm from bone.
• Management of neck is not mentioned in these guidelines.
17. 4. FROZEN SECTION AND MARGINS
Role of Frozen Section
Margin revision and how beneficial is it?
Consideration of initial / revised margin for
adjuvant radiotherapy
18. •Retrosprective analysis of 416 patients-229 with FS while 197 without FS
•Local failure was determined by age, T stage, N stage and Marginal status
•Chance of achieving clear margins not significantly improved by FS
19. •R1 TO R0 Vs RO Resection- R1 TO R0 Showed significantly worse 5-
years LRFS compared to R0
•R1 TO Negative vs R0 Resection:R1 TO Negative patient showed
significantly worse LRFS compared to R0
•R1 vs R1 TO R0 Resection-R1 showed a trend towards worse 5years
LRFS compared with R1 to R0 but did not reach any significance.
21. MARGINS
Historical cohort of 277 oral cancer patients.
5-year survival rate:
Margins>5mm-73%
3-4mm-69%
2mm or less-62%
Involved margins 39%
Advocated 3mm as adequate margin.
22.
23.
24. Adjuvant therapy
RISK FACTORS FOR ADJUVANT THERAPY
MAJOR FACTORS
•STAGE III/IV
•POSITIVE
MARGINS
•DEPTH OF
INVASION
•NODAL
METASTASIS
•EXTRACAPSULAR
SPREAD
MINOR FACTORS
•LVI
•PNI
•WORSE PATTERN
OF INVASION
•TUMOR BUDDING
25.
26.
27.
28.
29. ITF CLEARANCE
Assessment of ITF Involvement
Supra-notch vs Infra Notch disease
Signs of unressectability
Role of NACT in diseases involving ITF
Role of bony reconstructions following ITF
30. Assessment of ITF involvement
Assess with CT first
Check for the widening at mandibular canal or
pterygomaxillary fissure area.
If positive go for MRI
37. PATIENT EVALUATION?
Examination under anesthesia for large lesion.
DOI to be assessed on MRI
BOT,FOM, mucosa between dease and mandible
to be assessed for.
Severe trismus: Endoscopy, Imaging should be
considered.
39. CRITERIA OF RESSECTABILITY
Very advanced disease: Consider PET-CT
Evaluate the skull base: CECT and compliment
with CEMRI
UNRESSECTABILITY of primary disease:
A>Adequate surgical clearance is not achievabable
B>Extensive ITF involvement
C>Extensive involvement of Base of Skull
D>Extensive soft tissue disease.