Multidisciplinary Management of Oral Cavity and Maxillary Sinus Cancers

During the last 30 years the belief that oral/head and neck cancer management is based on team work has been established. The functions of tumor boards and combined clinics is a common contemporary practice with an exceedingly large number of medical, surgical, and other specialties being part of comprehensive, multidisciplinary therapeutic head and neck teams. The basic treatment modalities remain surgery, radiotherapy, and chemotherapy.Basic surgical techniques have not changed dramatically over the last 30 years. Among the major changes are the variations in the surgical management of the neck of both clinically negative and clinically positive neck patients, as well as the management of the mandible especially in the early invasion of oral squamous cell carcinoma in the mandibular bone. The revolution in the surgical treatment of oral/head and neck cancer is the introduction of reconstructive techniques with both pedicled locoregional flaps and free tissue transfer. These reconstructive techniques allowed for safer and wider resections with adequate disease-free margins and functional reconstruction of the created surgical defects.Contemporary radiotherapeutic treatment has very little similarities with that of the late 1970s. Modern technology with the institution of new forms of radiation and the application of sophisticated computerized methods have enhanced the therapeutic effectiveness of irradiation with an equal important reduction in the sparing in irradiation of normal surrounding tissues. This has led to an increased therapeutic dose in the tumorous site and a decreased severity of radiation-induced injuries. Alterations in the fractionations have also shown to produce better therapeutic results in selected cases.The era of methotrexate, the leading chemotherapeutic agent of the 1970s, was followed by the institution of platinum-based chemotherapies with or without the addition of 5 Fu. Adjuvant and neoadjuvant schemes coupled with pre- or postoperative radiotherapy started in the late 1980s and showed a distinct survival benefit over radiotherapy alone. This major breakthrough was followed by the institution of various and diverse chemoradiation regimes tested over a large time period for their survival benefits. The introduction of taxanes and the development of molecular targeted therapies during the last 5 years have revolutionized the concept of chemoradiation. Induction chemotherapy and chemoradiation coupled with epidermal growth factor receptor antagonists proved to have a survival benefit in patients with locally advanced or recurrent squamous cell carcinoma of the head and neck. Other biological agents against tumor angiogenesis or restoring cell apoptosis are being tested in various phase I or II trials.Perhaps the most promising noninvasive therapeutic method for squamous cell carcinoma of the oral mucosa is immunotherapy. The clinical applications so far are very limited but the research into these pathways is vast and extended.