Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4446_Библиотеки_им_академика_М_И_Перельмана

Surgery is the mainstay of treatment and primary modality of choice for locally advanced operable oral cancers (stage III, IVA). Results with pri­mary surgery are better than in the salvage setting in this group of patients. There have been two randomized trials to date attempting to address this issue, one of which had to be prematurely terminated while the other was overwhelmingly in favour of surgery [30, 31]. A recent NCDB study including 6900 patients of oral cancer dem­onstrated that surgery followed by adjuvant RT had better overall outcomes as compared to upfront chemoradiation when analysed for the entire cohort as well as for T3, T4a tumours [32]. Stage T4b cancers (masticator space-ITF com­plex involvement), considered inoperable earlier, could benet from surgery in a select subset of patients. Studies have demonstrated that low ITF involvement—described as the area below an imaginary line drawn through the sigmoid notch—could be offered surgery with acceptable outcomes [33–35]. It should be noted, however, that these studies are all focused on gingivo­buccal cancers and extrapolating this concept to other subsites of the oral cavity is without scien­tic justication. RT/CRT with a goal at organ preservation is inadequate because of the aggres­sive nature of oral cancers as well as the close proximity to the mandible. There have been few reports suggesting the possibility of its use in a select subset of patients with an unacceptably high rate of complications [36].