Computerized Tomography-Guided Surgical Decision-Making in Primary Squamous Cell Carcinoma of the Oral Cavity

Head and neck cancer is the sixth most common cancer worldwide [1]. One third of it comprises the oral cavity, while squamous cell carcinoma (SCC) represents approximately 95% of the dominating histopathology [2, 3]. In contrast to oropharyngeal squamous cell carcinoma, in which HPV-induced etiology is currently discussed to be associated with a better prognosis, OSCC still remains to be based on tobacco and alcohol as major risk factors [4–6]. Even though great emphasis is placed on early detection and optimized surgical and radio-oncologic techniques, the prognosis remains poor with overall 5-year survival beneath 50%, mainly due to a high rate of locoregional recurrences [1, 2, 7]. Furthermore organ-sparing concepts in terms of induction chemotherapy, currently under investigation in laryngeal malignancies, are not in focus in OSCC [8, 9]. Therefore two main therapeutic strategies remain: [1] upfront surgery followed by adjuvant radiotherapy (RT) or radiochemotherapy (RCT) if necessary, according to histopathologic risk factors, and [2] primary RCT followed by salvage surgery in case of residual disease. The aim of this chapter is to discuss the influence of findings by computed tomography, the worldwide most common imaging modality in head and neck cancer, on therapeutic strategies.