Adjuvant management of locally advanced oral squamous cell carcinoma - real-world challenges and opportunities

Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis

When presenting with major pathological risk factors, adjuvant radio-chemotherapy for oral cavity cancers (OCC) is recommended, but the addition of chemotherapy to radiotherapy (POCRT) when only minor pathological risk factors are present is controversial. A systematic review following the PICO-PRISMA methodology (PROSPERO registration ID: CRD42021267498) was conducted using the PubMed, Embase, and Cochrane libraries. Studies assessing outcomes of POCRT in patients with solely minor risk factors (perineural invasion or lymph vascular invasion; pN1 single; DOI ≥ 5 mm; close margin < 2−5 mm; node-positive level IV or V; pT3 or pT4; multiple lymph nodes without ENE) were evaluated. A meta-analysis technique with a single-arm study was performed. Radiotherapy was combined with chemotherapy in all studies. One study only included patients treated with POCRT. In the other 12 studies, patients were treated with only PORT (12,883 patients) and with POCRT (10,663 patients). Among the patients treated with POCRT, the pooled 3 year OS rate was 72.9% (95%CI: 65.5−79.2%); the pooled 3 year DFS was 70.9% (95%CI: 48.8−86.2%); and the pooled LRFS was 69.8% (95%CI: 46.1−86.1%). Results are in favor of POCRT in terms of OS but not significant for DFS and LRFS, probably due to the heterogeneity of the included studies and a combination of different prognostic factors.

Photothermal effect of indocyanine green modified scaffold inhibits oral squamous cell carcinoma and promotes wound healing

As the most prevalent malignant tumor of the oral and maxillofacial regions, squamous cell carcinoma (SCC) has relatively high recurrence and low survival rates. Currently, the most common treatment strategies are surgery and chemoradiotherapy. However, incomplete removal of the tumor can allow residual tumor cells to regrow and metastasis, resulting in treatment failure. Although postoperative adjuvant radiotherapy or chemotherapy can reduce recurrence, serious adverse reactions significantly compromise patients' quality of life. Large soft tissue defects after surgery are also difficult to heal. Therefore, therapies that eliminate residual tumor cells and promote tissue regeneration post-surgery are urgently needed. Indocyanine green (ICG) can convert absorbed light into heat to ablate tumor cells. Three-dimensional (3D) scaffolds are efficient drug carriers and support cell migration and proliferation. Here, we fabricated collagen/silk fibroin encapsulated ICG (I-CS) scaffolds by combining 3D printing with freeze-drying methods. The I-CS scaffolds delayed ICG decomposition and clearance, allowing the scaffolds to be used repeatedly for photothermal therapy (PTT). With the laser positioned at 4 cm from the 1.0 I-CS scaffold and irradiation for 10 min (1.0 W/cm²), temperatures above 50 °C were achieved, which effectively killed SCC-25 cells in vitro and suppressed tumor growth in vivo. Moreover, the I-CS scaffolds supported attachment and proliferation of rat buccal mucosa fibroblasts (RBMFs) and promoted the repair of buccal mucosal wounds in rats. These results suggested that I-CS scaffolds may be useful in preventing local recurrence and support regeneration of large soft tissue defects after oral SCC surgery.