Should infranotch T4b oral cavity cancer be downstage to T4a category?
Remo Accorona1, Pietro Perotti2, Armando De Virgilio3
1Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milano, Italy. dott.remoaccorona@gmail.com.
Purpose:
This comment aims to discuss the reliability of a radical resection of T4b oral squamous cell carcinomas with masticatory space involvement as well as analyze data in the literature on the oncologic outcomes compared to T4a.
Methods:
Clinical review of the scientific literature with focus on oral squamous cell carcinomas with masticatory space involvement.
Results:
The clinical review comprised 10 studies. The masticatory space is subdivided into infra- and supra-notch spaces according to the plane passing through the mandibular notch. En-bloc resection with compartmental approach demonstrated similar outcomes for infra-notch T4b oral cancers and T4a category.
Conclusion:
En-bloc compartmental resection of the masticatory space provides the best chances of margins control. Surgery should be considered the first line treatment option for this "borderline operable" category of cancers. Comparable survival outcomes between T4a and infra-notch T4b pushed several authors to suggest the downstaging the masticatory space involvement in oral cancer to T4a category.
