Should infranotch T4b oral cavity cancer be downstage to T4a category?

PURPOSE

This comment aims to discuss the reliability of a radical resection of T4b oral squamous cell carcinomas with masticatory space involvement as well as analyze data in the literature on the oncologic outcomes compared to T4a.

METHODS

Clinical review of the scientific literature with focus on oral squamous cell carcinomas with masticatory space involvement.

RESULTS

The clinical review comprised 10 studies. The masticatory space is subdivided into infra- and supra-notch spaces according to the plane passing through the mandibular notch. En-bloc resection with compartmental approach demonstrated similar outcomes for infra-notch T4b oral cancers and T4a category.

CONCLUSION

En-bloc compartmental resection of the masticatory space provides the best chances of margins control. Surgery should be considered the first line treatment option for this "borderline operable" category of cancers. Comparable survival outcomes between T4a and infra-notch T4b pushed several authors to suggest the downstaging the masticatory space involvement in oral cancer to T4a category.