Current radiation therapy management issues in oral cavity cancer

Oral cavity cancer presents a therapeutic challenge to the treating surgeons,radiation oncologists, and medical oncologists. In early-stage disease, surgery or radiation alone often achieves excellent local control. Patients who have risk factors for recurrence after surgery should undergo adjuvant radiotherapy or chemoradiotherapy. In locally advanced disease, recurrence rates and deaths caused by disease progression continue to be unacceptably high. During the past decade, multiple randomized studies have shown a benefit in the addition of chemotherapy to radiation in the definitive or postoperative setting. Also, hyperfractionated and concomitant boost radiotherapy has shown superior results when compared with conventional once-daily radiotherapy. The addition of chemotherapy to hyperfractionated or concomitant boost radiotherapy also seems to improve outcomes at the cost of increased toxicities. In addition to traditional therapeutic modalities, new targeted agents seem promising to improve outcomes and possibly allow use of decreased doses of chemotherapy or radiotherapy, thus decreasing the toxicity of treatment.Overall, the management of cancer of the oral cavity is evolving rapidly,and a multidisciplinary approach to the patient who has oral cavity cancer is important to ensure the highest quality of patient care.