♦ Multidisciplinary approach is essential —maxillofacial, plastics, dental

—radiation oncologist —dietician —speech therapist

♦ Surgery for early tumours

♦ Primary radiotherapy and reserve surgery for salvage

♦ Neck dissection for positive nodes

♦ Large lesions require osteomyocutaneous flap reconstruction

♦ If locally advanced—combination of surgery and radiotherapy Radiation therapy is planned taking account not only of all clinical and radiological evidence of the tumour but also the likely sites of occult nodal disease. Doses of 50-65 Gy are delivered to the tumour volume, depending on the extent of residual tumour. At least part of this dose can be delivered by interstitial therapy, often using iridium wire. Inevitably radical irradiation of the oral cavity causes mucositis and a dry mouth, that may persist depending on the amount of salivary tissue spared from irradiation. Chronic ulceration of the mucosa and osteonecrosis are risks, particularly with locally advanced tumours involving the mandible.

As with head and neck squamous cancers at other sites, chemotherapy (cisplatin, 5-fluorouarcil, methotrexate, bleomycin) is active in advanced disease, but there is no proven benefit for chemotherapy given as either adjuvant or neo-adjuvant therapy.

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