Treatment Options Under Clinical Evaluation for All Stage III Lip and Oral Cavity Cancers

Chemotherapy has been combined with radiation therapy in patients who have locally advanced disease that is surgically unresectable.[8,10,14,15]A meta-analysis of 63 randomized prospective trials published between 1965 and 1993 showed an 8% absolute survival advantage in the subset of patients who received concurrent chemotherapy and radiation therapy.[16][Level of evidence B4] Patients who received adjuvant or neoadjuvant chemotherapy had no survival advantage. Cost, quality of life, and morbidity data were not available. No standard regimen existed, and the trials were felt to be too heterogenous to provide definitive recommendations. The results of 18 ongoing trials may further clarify the role of concurrent chemotherapy and radiation therapy in the management of oral cavity cancer.The best chemotherapy to use and the appropriate way to integrate the two modalities is still unresolved.[17]Similar approaches in the patient with resectable disease, in whom resection would lead to a major functional deficit, are also being explored in randomized trials but cannot be recommended at this time as standard.

Clinical trials of novel fractionation radiation therapy are under evaluation.[13]