Reclassifying cT4b buccal mucosa/gingivobuccal complex cancers: do we need to change?

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer

Background:

• T4b oral cavity carcinomas are locally advanced, often considered borderline resectable or unresectable.
• The role of surgical intervention for these advanced tumors remains incompletely defined.

Purpose of the Study:

• To re-evaluate the feasibility and oncological outcomes of surgical resection for clinically staged T4b oral cavity carcinomas.
• To identify prognostic factors influencing survival in this patient cohort.

Main Methods:

• Retrospective evaluation of 218 patients with cT4b oral cancer treated between 2013 and 2021.
• Patients underwent composite resection, with or without neoadjuvant chemotherapy, and selective infratemporal fossa (ITF) clearance for advanced disease.
• Oncological outcomes and prognostic factors were analyzed.

Main Results:

• The median follow-up was 54 months, with 5-year survival rates of 54% (locoregional control), 52% (disease-free survival), and 59% (overall survival).
• Multivariate analysis identified nodal disease, perineural invasion, and bone involvement as significant negative prognostic factors for overall survival.
• Surgery was feasible, with acceptable outcomes despite advanced disease stage.

Conclusions:

• Surgical resection for cT4b oral cavity cancer is a viable treatment option.
• Careful patient selection and surgical technique, including potential ITF clearance, can lead to acceptable oncological results.
• Nodal status, perineural invasion, and bone involvement are critical prognostic indicators for survival.