Surgery or chemo- Selection criteria for mode of treatment in older patients of oral squamous cell carcinoma

A team of researchers has recently published critical factors for selecting the mode of treatment in older people suffering from oral squamous cell carcinoma (OSCC) in the Dentistry Journal . Older patients suffering from OSCC have many problems when opting for surgery other than considering the age factor. The treatment modality for oral squamous cell carcinoma was believed to be determined by the progression of the disease, age, physical & nutritional status of patients, and desire.

The current study focused on determining the factors proving to be the selective criteria for undergoing curative surgical treatment in old aged people suffering from OSCC to increase the survival rate. The research included 76 patients aged 70 years or above suffering from OSCC, of which 52 patients were treated with surgery & 24 were treated with non-surgical treatment that provides radiotherapy and/or chemotherapy.

Selection of the treatment mode (surgical/non-surgical) has been dependent on many vital factors, i.e., decision factors (DF), performance status (PS), clinical status, TN classification, clinical stage, serum albumin level (Alb), body mass index ( BMI), geriatric nutritional risk index (GNRI). The people were divided into two groups, i.e., surgical & non-surgical, based on patients who have undergone surgery and those who have opted for the palliative treatment depending on the condition of a patient, tumor stage, medical condition, PS, daily living activities and most importantly patients own choice. Their current research started with the comparison between the surgical & non-surgical groups based on factors mentioned earlier.

Previous studies have confirmed less probability of curative treatment received for patients with head and neck cancer (HANC). The current research revealed some interesting facts according to the Decision Tree Analysis:

PS - Differences in the surgical and non-surgical groups have been observed significantly. PS is considered the indicator of assessment of general conditions based on limited daily activity. Poor PS value leads to avoidance of surgery.

Noticeable differences have been observed for TN classification & clinical stage, GNRI & serum albumin for both groups.

Patients were classified according to the serum albumin level: less or equal to 3.5 g/dl & more than similar to 3.5 g/dl.

For an indication of surgery, the value of serum Album is more than equal to 3.5 g/dl with PS 0 & stage I, II.

For an indication of non-surgical treatment, the value of serum Alb is less than equal to 3.5 g/dl with stages III, I, and V.

Research confirmed the importance of serum albumin as it indicates the nutritional status in the mid to long run, including cachexia. Serum albumin level is a crucial factor being reduced in case of malignancy and inflammation. The role of nutritional status has been assessed thoroughly as it is directly associated with immune function & wound healing.

The research concluded the importance of PS, stage classification & serum Alb as essential criteria for surgery in elderly patients with oral squamous cell carcinoma. This study also shows the future aspect of better management of OSCC with a higher prognosis.

For the full article, visit the given link below: https://www.mdpi.com/2304-6767/11/1/6

Source: Dentistry Journal

Dentistry Journal