Oral cancer management includes surgery or radiotherapy, with or without systemic therapy such as chemotherapy and targeted therapy. The operation is still the primary treatment modality for oral cancer. Although NCCN guidelines recommended primary definitive radiation therapy, this was not routinely used due to higher therapeutic doses required than adjuvants doses, resulting in the higher of complications. Primary concomitant chemo-radiotherapy usually performed for patients who are unsuited for surgery.
Postoperative radiation therapy (PORT) indicated for advanced disease, extracapsular extension, positive margins, perineural invasion and lymphovascular invasion. The addition of PORT improves survival and locoregional control. Intensity Modulation Radiation Therapy enhanced radiation toxicity related Quality of Life and minimize post-treatment care.
The use of neoadjuvant chemotherapy has minimum benefits concerning DFS and OS, despite tumor shrinkage. However, platinum-based chemotherapy adjuvants along with radiation in patients with advanced stage increases locoregional control improved DFS and OS.
EGFR over-expression was found in oral cancer and had been reported associated with poor prognosis. Targeting EGFR therapy such as cetuximab has emerged the U.S. potential modalities in combination with chemoradiotherapy to improve eradication of the cancers. Novel molecular targeting therapies have been explored for oral cancer therapy.
Photodynamic therapy is a treatment modality involving administration of photosensitizers, followed by light irradiation. In oxygen riched tissue resulted in cytotoxic free radicals that caused the direct tumor cells death, microvascular damage, and induction of inflammatory reactions at the target sites. Currently, a photodynamic therapy used as a palliative treatment for resistant, relapse, or resistant to treatment of head and neck cancers.
Deficiency of specific immune systems may contribute to long-term treatment outcomes of oral cancer. Immunotherapy was intended to stimulate the durable immune system against cancer cell, with a single-like cytokine IL-2, Interferon-α-ɤ, Interferon or a combination of cytokines such as IRX-2, represent the future directions in the treatment of Oral cancer.
The selection of treatment modalities might take consideration of probability cancer eradication, preventing cancer relapse, acceptable of oral function and cosmetic outcomes, performance status, and availability of resources and expertise.
Key words: Oral cancer, CRT, PORT, Chemotherapy, Immunotherapy, Photodynamic