In oral cavity cancers, tumors invading the bone marrow of the mandible or maxilla have traditionally been classified as T4a in the TNM staging system. This study evaluated the impact of bone invasion on T classification and survival in patients with squamous cell carcinoma of the oral cavity.
Materials and methods
We retrospectively reviewed and restaged 2,143 patients treated between 2001 and 2019. Bone invasion was categorized as no bone invasion, non-mandibular canal (MC) bone marrow invasion, or MC invasion. Disease-specific survival (DSS) was the primary endpoint. Prognostic performance was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Discriminative ability was evaluated with Harrell’s concordance index (C-index) and calibration analysis.
Results
Among 505 T4a tumors, 271 (53.7%) were classified as T4a solely due to bone marrow invasion, and their survival outcomes were comparable to those of T3 tumors. In multivariate analysis, MC invasion was independently associated with worse DSS, whereas non-MC bone marrow invasion was not. Based on these findings, we developed two revised versions of the MC-T classification for oral tumors, replacing bone marrow invasion with MC invasion as a T4a criterion in the 8th edition UICC/AJCC T classification. Both MC-T classifications showed superior prognostic discrimination, with higher C-indices than the original system.
Conclusions
Patients with T4a oral tumors classified solely by bone marrow invasion had survival outcomes similar to those with T3 tumors. The proposed MC-T classification improves prognostic accuracy by more effectively stratifying T4a tumors.
背景与目的：在口腔癌中，侵袭下颌骨或上颌骨髓的肿瘤在TNM分期系统中传统上被归类为T4a。本研究评估骨浸润对口腔鳞状细胞癌患者T分类和生存的影响。材料和方法：我们对2001年至2019年期间接受治疗的2143例患者进行了回顾性研究和再治疗。骨侵犯分为无骨侵犯、非下颌管（MC）骨髓侵犯和下颌管侵犯。疾病特异性生存（DSS）是主要终点。采用Kaplan-Meier分析和Cox比例风险模型评估预后。采用Harrell’s concordance index （C-index）和校正分析评价辨别力。结果505例T4a肿瘤中有271例（53.7%）仅因骨髓侵袭被归为T4a，其生存结局与T3肿瘤相当。在多变量分析中，MC侵袭与DSS恶化独立相关，而非MC骨髓侵袭与DSS恶化无关。基于这些发现，我们制定了两个修订版本的口腔肿瘤MC-T分类，在第8版UICC/AJCC T分类中以MC侵袭取代骨髓侵袭作为T4a标准。两种MC-T分类均具有较好的预后判别能力，其c指数均高于原分类系统。结论：单纯以骨髓侵袭分类的T4a口腔肿瘤患者的生存结局与T3肿瘤相似。提出的MC-T分类通过更有效地对T4a肿瘤进行分层，提高了预后准确性。
{"title":"T4a classification for oral cancer using mandibular canal invasion instead of bone marrow invasion in the TNM staging system","authors":"Masaya Okura , Nobuhiro Yamakawa , Mitsunobu Otsuru , Takumi Hasegawa , Yusuke Yokota , Shin Rin , Hironori Sakai , Shin-ichi Yamada , Eiji Hirai , Yuichi Ashikaga , Kozo Yamamoto , Michihiro Ueda , Tadaaki Kirita , Masahiro Umeda , Masaya Akashi , Hiroshi Kurita , Yoichi Ohiro , Tomofumi Naruse , Souichi Yanamoto , Japan Oral Oncology Group JOOG","doi":"10.1016/j.oraloncology.2025.107771","DOIUrl":"10.1016/j.oraloncology.2025.107771","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In oral cavity cancers, tumors invading the bone marrow of the mandible or maxilla have traditionally been classified as T4a in the TNM staging system. This study evaluated the impact of bone invasion on T classification and survival in patients with squamous cell carcinoma of the oral cavity.</div></div><div><h3>Materials and methods</h3><div>We retrospectively reviewed and restaged 2,143 patients treated between 2001 and 2019. Bone invasion was categorized as no bone invasion, non-mandibular canal (MC) bone marrow invasion, or MC invasion. Disease-specific survival (DSS) was the primary endpoint. Prognostic performance was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Discriminative ability was evaluated with Harrell’s concordance index (C-index) and calibration analysis.</div></div><div><h3>Results</h3><div>Among 505 T4a tumors, 271 (53.7%) were classified as T4a solely due to bone marrow invasion, and their survival outcomes were comparable to those of T3 tumors. In multivariate analysis, MC invasion was independently associated with worse DSS, whereas non-MC bone marrow invasion was not. Based on these findings, we developed two revised versions of the MC-T classification for oral tumors, replacing bone marrow invasion with MC invasion as a T4a criterion in the 8th edition UICC/AJCC T classification. Both MC-T classifications showed superior prognostic discrimination, with higher C-indices than the original system.</div></div><div><h3>Conclusions</h3><div>Patients with T4a oral tumors classified solely by bone marrow invasion had survival outcomes similar to those with T3 tumors. The proposed MC-T classification improves prognostic accuracy by more effectively stratifying T4a tumors.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107771"},"PeriodicalIF":3.9,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.oraloncology.2025.107775
Annu Singh , Teeradon Treechairusame , Edward Christopher Dee , Joseph M. Huryn , Cherry L. Estilo , Nancy Y. Lee
{"title":"Reply to the comment on “Osteoradionecrosis as a complication following post-operative intensity-modulated radiation therapy or proton therapy for oral cavity cancers","authors":"Annu Singh , Teeradon Treechairusame , Edward Christopher Dee , Joseph M. Huryn , Cherry L. Estilo , Nancy Y. Lee","doi":"10.1016/j.oraloncology.2025.107775","DOIUrl":"10.1016/j.oraloncology.2025.107775","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107775"},"PeriodicalIF":3.9,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.oraloncology.2025.107768
Cecelia M. Hidalgo , Gabriel A. Hernandez-Herrera , Courtney N. Day , Felicia Olawuni , Chadi N. Abdel-Halim , Kathryn M. Van Abel , David M. Routman , Linda X. Yin
Purpose
De-escalation trials in human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) have led to variable institutional treatment algorithms. It is unclear whether treatment options are offered equally throughout the United States. This study assesses how social determinants of health (SDOH), and treatment facility type impact access to surgery and/or high-quality radiotherapy (RT) for HPV + OPSCC.
Results
Among 6,458 patients, the median age was 62, 93.1 % were White, and 79.2 % had no significant comorbidities. Patients with the highest education, income, and private insurance (p ≤ 0.002 for all) underwent more surgery. Patients with lower education and income presented with more advanced disease (each p < 0.001). Care at academic facilities was the strongest predictor of surgery for early-stage disease (aOR:6.17, 95 % CI:3.74–10.18, p < 0.001) and was more likely to result in a margin-negative resection (p = 0.017). Delays in TTI were highest among Black patients, uninsured patients, patients with low socioeconomic status (SES), and patients receiving care at academic facilities (p ≤ 0.011 for all). Patients with significant comorbidities were more likely to experience delays in TTA (p = 0.018) and TTC (p = 0.036). There were no differences in delays in TTA or TTC based on treatment facility.
Conclusions
SDOH affect access to surgery for HPV + OPSCC, with patients of low SES presenting with more advanced disease. Among early-stage cases, access to surgery is significantly greater at academic facilities, which offer superior surgical outcomes. Treatment completion times are comparable between academic and community facilities, suggesting that poor surgical candidates should pursue care at the facility offering the fastest treatment initiation and completion.
{"title":"Access to surgery and high-quality radiotherapy for human papillomavirus related oropharynx cancer","authors":"Cecelia M. Hidalgo , Gabriel A. Hernandez-Herrera , Courtney N. Day , Felicia Olawuni , Chadi N. Abdel-Halim , Kathryn M. Van Abel , David M. Routman , Linda X. Yin","doi":"10.1016/j.oraloncology.2025.107768","DOIUrl":"10.1016/j.oraloncology.2025.107768","url":null,"abstract":"<div><h3>Purpose</h3><div>De-escalation trials in human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV + OPSCC) have led to variable institutional treatment algorithms. It is unclear whether treatment options are offered equally throughout the United States. This study assesses how social determinants of health (SDOH), and treatment facility type impact access to surgery and/or high-quality radiotherapy (RT) for HPV + OPSCC.</div></div><div><h3>Results</h3><div>Among 6,458 patients, the median age was 62, 93.1 % were White, and 79.2 % had no significant comorbidities. Patients with the highest education, income, and private insurance (p ≤ 0.002 for all) underwent more surgery. Patients with lower education and income presented with more advanced disease (each p < 0.001). Care at academic facilities was the strongest predictor of surgery for early-stage disease (aOR:6.17, 95 % CI:3.74–10.18, p < 0.001) and was more likely to result in a margin-negative resection (p = 0.017). Delays in TTI were highest among Black patients, uninsured patients, patients with low socioeconomic status (SES), and patients receiving care at academic facilities (p ≤ 0.011 for all). Patients with significant comorbidities were more likely to experience delays in TTA (p = 0.018) and TTC (p = 0.036). There were no differences in delays in TTA or TTC based on treatment facility.</div></div><div><h3>Conclusions</h3><div>SDOH affect access to surgery for HPV + OPSCC, with patients of low SES presenting with more advanced disease. Among early-stage cases, access to surgery is significantly greater at academic facilities, which offer superior surgical outcomes. Treatment completion times are comparable between academic and community facilities, suggesting that poor surgical candidates should pursue care at the facility offering the fastest treatment initiation and completion.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107768"},"PeriodicalIF":3.9,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-09DOI: 10.1016/j.oraloncology.2025.107742
Rose Doerfler , Jie Chen , Carl Kim , Joshua D. Smith , Micah Harris , Krishna B. Singh , Brian Isett , Rebekah E. Dadey , Daniel D. Brown , Adrian V. Lee , Xuefeng Wang , Matthew E. Spector , Seungwon Kim , Shaum Sridharan , Kevin Contrera , Katelyn Smith , Carly Reeder , Maureen Lyons , Jianhua Luo , Silvia Liu , Riyue Bao
Patient-derived organoids (PDOs) emerge as advanced 3D ex vivo New Approach Methodologies (NAM) preclinical models, offering significant advantages over traditional cell lines and monolayer cultures for therapeutic development. In this study, we established PDOs from surgically resected fresh tissues of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) across anatomical sites, tumor T-categories, and sample types. These PDOs faithfully recapitulate the tumor’s pathology, mutational profile, and drug response. To enable rapid classification of PDO identity, we developed a new convolutional neural network (CNN) model, TransferNet-PDO, which accurately distinguished tumor versus normal PDOs in culture using digital histopathology images (AUC ≥ 0.88). PDOs maintained stable cultures and were cryopreserved between passages 5 and 12. Immunohistochemistry (IHC) staining (PanCK, p63, Cytokeratin 13, Ki67) confirmed squamous phenotype and histologic aggression of the original tumor. For tumors harboring TP53 mutations by whole-exome sequencing (WES), PDOs retained the corresponding p53 functional status as confirmed by IHC (enhanced or loss of protein expression). Somatic mutational landscape revealed that PDOs preserved driver somatic mutations, copy number variations (CNVs), and clonal architecture including low-prevalence subclones. Drug sensitivity assessment of PDOs showed that cisplatin reduced cell viability, whereas cetuximab and lenvatinib had minimal effects. Chemoradiation led to greater tumor organoid killing compared to radiation or chemotherapy alone. This study presents an integrated HNSCC PDO platform combining tissue biobanking, organoid establishment, multiomics characterization, functional drug screening, and AI-driven histopathologic classification, providing a comprehensive and scalable system for translational cancer research.
{"title":"Integrating artificial intelligence-driven digital pathology and genomics to establish patient-derived organoids as new approach methodologies for drug response in head and neck cancer","authors":"Rose Doerfler , Jie Chen , Carl Kim , Joshua D. Smith , Micah Harris , Krishna B. Singh , Brian Isett , Rebekah E. Dadey , Daniel D. Brown , Adrian V. Lee , Xuefeng Wang , Matthew E. Spector , Seungwon Kim , Shaum Sridharan , Kevin Contrera , Katelyn Smith , Carly Reeder , Maureen Lyons , Jianhua Luo , Silvia Liu , Riyue Bao","doi":"10.1016/j.oraloncology.2025.107742","DOIUrl":"10.1016/j.oraloncology.2025.107742","url":null,"abstract":"<div><div>Patient-derived organoids (PDOs) emerge as advanced 3D ex vivo New Approach Methodologies (NAM) preclinical models, offering significant advantages over traditional cell lines and monolayer cultures for therapeutic development. In this study, we established PDOs from surgically resected fresh tissues of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) across anatomical sites, tumor T-categories, and sample types. These PDOs faithfully recapitulate the tumor’s pathology, mutational profile, and drug response. To enable rapid classification of PDO identity, we developed a new convolutional neural network (CNN) model, TransferNet-PDO, which accurately distinguished tumor <em>versus</em> normal PDOs in culture using digital histopathology images (AUC ≥ 0.88). PDOs maintained stable cultures and were cryopreserved between passages 5 and 12. Immunohistochemistry (IHC) staining (PanCK, p63, Cytokeratin 13, Ki67) confirmed squamous phenotype and histologic aggression of the original tumor. For tumors harboring TP53 mutations by whole-exome sequencing (WES), PDOs retained the corresponding p53 functional status as confirmed by IHC (enhanced or loss of protein expression). Somatic mutational landscape revealed that PDOs preserved driver somatic mutations, copy number variations (CNVs), and clonal architecture including low-prevalence subclones. Drug sensitivity assessment of PDOs showed that cisplatin reduced cell viability, whereas cetuximab and lenvatinib had minimal effects. Chemoradiation led to greater tumor organoid killing compared to radiation or chemotherapy alone. This study presents an integrated HNSCC PDO platform combining tissue biobanking, organoid establishment, multiomics characterization, functional drug screening, and AI-driven histopathologic classification, providing a comprehensive and scalable system for translational cancer research.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107742"},"PeriodicalIF":3.9,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145489953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1016/j.oraloncology.2025.107774
Araceli Diez-Fraile , Lies Pottel , Philippe Lamoral , Tom De Backer , Christophe Spaas , Raf Van Hoeyweghen , Tom Vauterin , Catherine Dick , Johan Abeloos , Joke De Ceulaer
{"title":"Age and surgical complexity outperform preoperative Geriatric-8 for 30-day major complications in older head and neck cancer","authors":"Araceli Diez-Fraile , Lies Pottel , Philippe Lamoral , Tom De Backer , Christophe Spaas , Raf Van Hoeyweghen , Tom Vauterin , Catherine Dick , Johan Abeloos , Joke De Ceulaer","doi":"10.1016/j.oraloncology.2025.107774","DOIUrl":"10.1016/j.oraloncology.2025.107774","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107774"},"PeriodicalIF":3.9,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.oraloncology.2025.107773
Jenefar Sudarson
The recent paper by Pan et al. (2025), entitled “Transoral robotic surgery in oral tongue cancer patients with trismus: a retrospective evaluation of feasibility and surgical outcomes,” marks an important milestone in head and neck surgery. This commentary highlights that transoral robotic surgery (TORS) is safe and effective for oral tongue cancer patients, trismus. The high negative margin rate (98.5%) and absence of complications or conversions to open surgery provide strong evidence for the feasibility and oncological efficacy of TORS. The study suggests that improved mouth opening post-operatively, through release of fibrotic tissue intra-operatively, offers a two-fold benefit of oncologic surgical resection and trismus relief. These outcomes are consistent with the gradual shift in surgical paradigms emphasizing function preservation and improving access through precision. Although retrospective and single center, multicenter and prospective trials assessing functional recovery, trismus recurrence and quality of life should be conducted. The study arrives at an optimal time, redefining surgical candidacy and enhancing robotic surgery application for complex malignancies in the oral cavity.
{"title":"Commentary on “Transoral robotic surgery in oral tongue cancer patients with trismus: A retrospective evaluation of feasibility and surgical outcomes,”","authors":"Jenefar Sudarson","doi":"10.1016/j.oraloncology.2025.107773","DOIUrl":"10.1016/j.oraloncology.2025.107773","url":null,"abstract":"<div><div>The recent paper by Pan et al. (2025), entitled “<em>Transoral robotic surgery in oral tongue cancer patients with trismus: a retrospective evaluation of feasibility and surgical outcomes</em>,” marks an important milestone in head and neck surgery. This commentary highlights that transoral robotic surgery (TORS) is safe and effective for oral tongue cancer patients, trismus. The high negative margin rate (98.5%) and absence of complications or conversions to open surgery provide strong evidence for the feasibility and oncological efficacy of TORS. The study suggests that improved mouth opening post-operatively, through release of fibrotic tissue intra-operatively, offers a two-fold benefit of oncologic surgical resection and trismus relief. These outcomes are consistent with the gradual shift in surgical paradigms emphasizing function preservation and improving access through precision. Although retrospective and single center, multicenter and prospective trials assessing functional recovery, trismus recurrence and quality of life should be conducted. The study arrives at an optimal time, redefining surgical candidacy and enhancing robotic surgery application for complex malignancies in the oral cavity.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107773"},"PeriodicalIF":3.9,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.oraloncology.2025.107772
Paulien Van Loocke , Benoit Beuselinck , Jeroen Meulemans , Sandra Nuyts , Robin Willaert , Davide Di Santo , Esther Hauben , Robert Hermans , Abhishek D. Garg , Vincent Vander Poorten , Oliver Bechter , Paul M. Clement
{"title":"Impact of time-of-day administration of immune checkpoint inhibitors on survival outcomes in patients with recurrent/metastatic head and neck cancer (R/M HNSCC): a retrospective cohort study","authors":"Paulien Van Loocke , Benoit Beuselinck , Jeroen Meulemans , Sandra Nuyts , Robin Willaert , Davide Di Santo , Esther Hauben , Robert Hermans , Abhishek D. Garg , Vincent Vander Poorten , Oliver Bechter , Paul M. Clement","doi":"10.1016/j.oraloncology.2025.107772","DOIUrl":"10.1016/j.oraloncology.2025.107772","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107772"},"PeriodicalIF":3.9,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.oraloncology.2025.107770
Giancarlo Tirelli, Paolo Boscolo-Rizzo
{"title":"Perioperative pembrolizumab and the changing paradigm of adjuvant therapy in head and neck squamous cell carcinoma: the case of T1-2, pN1","authors":"Giancarlo Tirelli, Paolo Boscolo-Rizzo","doi":"10.1016/j.oraloncology.2025.107770","DOIUrl":"10.1016/j.oraloncology.2025.107770","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107770"},"PeriodicalIF":3.9,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.oraloncology.2025.107766
Victorine Maso , Jerome R Lechien , Isabelle Gengler , Carlos Chiesa-Estomba , Johannes J. Fagan , Sheng-Po Hao , Luiz P. Kowalski , Bernard Lyons , Emmanuel Babin , Mohamad Yunus Mohd Razif , Hani Z. Marzouki , Angel Ramos Macias , Hector E. Ruiz , Antonino Maniaci , Bernard Fraysse , Matthew White , Justin Michel , Nicolas Fakhry
Objectives
To evaluate worldwide medical practices of otolaryngology centers in managing patients with Head And Neck Cancer (HNC)
Materials and Methods
We performed an online survey sent to otorhinolaryngologists worldwide via the IFOS between February and March 2024. The following aspects were evaluated: personal characteristics, diagnostics modalities, treatments, global management, cultural specificities and clinical cases. We compared results between centers in different geographical areas: Europe, North America, South and Central America, Asia, Africa Sub-Saharan, Oceania, and Middle East & North Africa (MENA).
Results
A total of 566 otorhinolaryngologists from 457 centers in 101 countries responded. International guideline adherence was lower in North America (45.5 %) than globally (74.5 %; p = 0.005). HPV/p16 testing was less common in Africa (28.9 %) and MENA (60.8 %) versus other regions (92.8 %; p < 0.001). PD-L1 testing was frequent in Europe (84.6 %) but rare in Africa (5.3 %; p < 0.001). Multidisciplinary Tumor Boards were systematic in Europe (88.9 %) and Oceania (87.5 %) but used selectively elsewhere. Intensity-modulated radiation therapy use was lower in Africa (28.9 %) and MENA (64.6 %; p < 0.001). A total of 95.7 % of centers had access to chemotherapy, with no differences between regions (p = 0.236). African centers cited cost as a major barrier (79.5 % vs. 33.8 %; p < 0.001). MRI and PET/CT access was significantly lower in Africa (51.2 % and 5 %), Central/South America (79.5 % and 47.7 %), and MENA (80.9 % and 43.8 %) than other regions (89.5 % and 73.2 %; p < 0.001).
Conclusion
The management of HNC exhibits significant variability worldwide. International guidelines should consider the economic, cultural, and geographic specificities of each continent to ensure context-sensitive care.
{"title":"Management of head and neck cancer around the world: an international survey by the world ear, nose, and throat federation","authors":"Victorine Maso , Jerome R Lechien , Isabelle Gengler , Carlos Chiesa-Estomba , Johannes J. Fagan , Sheng-Po Hao , Luiz P. Kowalski , Bernard Lyons , Emmanuel Babin , Mohamad Yunus Mohd Razif , Hani Z. Marzouki , Angel Ramos Macias , Hector E. Ruiz , Antonino Maniaci , Bernard Fraysse , Matthew White , Justin Michel , Nicolas Fakhry","doi":"10.1016/j.oraloncology.2025.107766","DOIUrl":"10.1016/j.oraloncology.2025.107766","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate worldwide medical practices of otolaryngology centers in managing patients with Head And Neck Cancer (HNC)</div></div><div><h3>Materials and Methods</h3><div>We performed an online survey sent to otorhinolaryngologists worldwide via the IFOS between February and March 2024. The following aspects were evaluated: personal characteristics, diagnostics modalities, treatments, global management, cultural specificities and clinical cases. We compared results between centers in different geographical areas: Europe, North America, South and Central America, Asia, Africa Sub-Saharan, Oceania, and Middle East & North Africa (MENA).</div></div><div><h3>Results</h3><div>A total of 566 otorhinolaryngologists from 457 centers in 101 countries responded. International guideline adherence was lower in North America (45.5 %) than globally (74.5 %; p = 0.005). HPV/p16 testing was less common in Africa (28.9 %) and MENA (60.8 %) versus other regions (92.8 %; p < 0.001). PD-L1 testing was frequent in Europe (84.6 %) but rare in Africa (5.3 %; p < 0.001). Multidisciplinary Tumor Boards were systematic in Europe (88.9 %) and Oceania (87.5 %) but used selectively elsewhere. Intensity-modulated radiation therapy use was lower in Africa (28.9 %) and MENA (64.6 %; p < 0.001). A total of 95.7 % of centers had access to chemotherapy, with no differences between regions (p = 0.236). African centers cited cost as a major barrier (79.5 % vs. 33.8 %; p < 0.001). MRI and PET/CT access was significantly lower in Africa (51.2 % and 5 %), Central/South America (79.5 % and 47.7 %), and MENA (80.9 % and 43.8 %) than other regions (89.5 % and 73.2 %; p < 0.001).</div></div><div><h3>Conclusion</h3><div>The management of HNC exhibits significant variability worldwide. International guidelines should consider the economic, cultural, and geographic specificities of each continent to ensure context-sensitive care.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107766"},"PeriodicalIF":3.9,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The standard treatment for locally advanced oral squamous cell carcinoma (OSCC) involves radical surgery followed by adjuvant therapy, often resulting in significant functional impairment. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising strategy to facilitate surgical de-escalation while preserving oncologic outcomes. This study evaluates the feasibility of response-adapted surgery (RAS) following NICT in OSCC.
Methods
In this retrospective analysis, 152 patients with previously untreated OSCC received NICT followed by either RAS (n = 66) or traditional surgery (TS, n = 86). RAS was tailored to post-NICT tumor regression, while TS adhered to pretreatment tumor extent. Primary endpoints were 3-year event-free survival (EFS) and overall survival (OS). Secondary endpoints included quality of life (QoL, assessed via EORTC QLQ-HN35) and perioperative complications.
Results
The RAS and TS cohorts exhibited comparable 3-year EFS (78.8 % vs. 79.1 %, p = 0.944) and OS (90.9 % vs. 91.9 %, p = 0.826). RAS significantly reduced the need for mandibulectomy (16.7 % vs. 41.9 %, p = 0.009) and free flap reconstruction (15.2 % vs. 48.8 %, p = 0.018), with fewer major complications (4.5 % vs. 11.6 %, p = 0.048). QoL metrics favored RAS, particularly in swallowing (15 ± 3.8 vs. 28 ± 5.5, p < 0.001) and speech (14 ± 3.9 vs. 25 ± 5.2, p < 0.001) at 12 months. Major pathologic response and PD-L1 CPS > 20 were associated with improved survival.
Conclusions
RAS after NICT achieves oncologic outcomes equivalent to TS while significantly reducing treatment-related morbidity and improving functional recovery. These findings support RAS as a viable de-escalation strategy for OSCC, aligning with the goals of precision oncology. Prospective trials are needed to validate long-term efficacy and refine patient selection criteria.
{"title":"Response-adapted surgery after neoadjuvant immunochemotherapy in oral squamous cell carcinoma","authors":"Qigen Fang , Junhui Yuan , Xu Zhang , Tao Huang , Lanwei Guo","doi":"10.1016/j.oraloncology.2025.107769","DOIUrl":"10.1016/j.oraloncology.2025.107769","url":null,"abstract":"<div><h3>Objective</h3><div>The standard treatment for locally advanced oral squamous cell carcinoma (OSCC) involves radical surgery followed by adjuvant therapy, often resulting in significant functional impairment. Neoadjuvant immunochemotherapy (NICT) has emerged as a promising strategy to facilitate surgical de-escalation while preserving oncologic outcomes. This study evaluates the feasibility of response-adapted surgery (RAS) following NICT in OSCC.</div></div><div><h3>Methods</h3><div>In this retrospective analysis, 152 patients with previously untreated OSCC received NICT followed by either RAS (n = 66) or traditional surgery (TS, n = 86). RAS was tailored to post-NICT tumor regression, while TS adhered to pretreatment tumor extent. Primary endpoints were 3-year event-free survival (EFS) and overall survival (OS). Secondary endpoints included quality of life (QoL, assessed via EORTC QLQ-HN35) and perioperative complications.</div></div><div><h3>Results</h3><div>The RAS and TS cohorts exhibited comparable 3-year EFS (78.8 % vs. 79.1 %, p = 0.944) and OS (90.9 % vs. 91.9 %, p = 0.826). RAS significantly reduced the need for mandibulectomy (16.7 % vs. 41.9 %, p = 0.009) and free flap reconstruction (15.2 % vs. 48.8 %, p = 0.018), with fewer major complications (4.5 % vs. 11.6 %, p = 0.048). QoL metrics favored RAS, particularly in swallowing (15 ± 3.8 vs. 28 ± 5.5, p < 0.001) and speech (14 ± 3.9 vs. 25 ± 5.2, p < 0.001) at 12 months. Major pathologic response and PD-L1 CPS > 20 were associated with improved survival.</div></div><div><h3>Conclusions</h3><div>RAS after NICT achieves oncologic outcomes equivalent to TS while significantly reducing treatment-related morbidity and improving functional recovery. These findings support RAS as a viable de-escalation strategy for OSCC, aligning with the goals of precision oncology. Prospective trials are needed to validate long-term efficacy and refine patient selection criteria.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"171 ","pages":"Article 107769"},"PeriodicalIF":3.9,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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