The Advanced Buccal Mucosa Cancer Involving Masticator Space (T4B): New Classification And Outcome Of Newer Surgical Technique (Compartment Resection).

INTRODUCTION: The buccal-complex tumors with masticator space involvement (T4b) have variable outcome and are treated with different protocols ranging from conventional surgery, NACT-surgery, CTRT or palliative care. . PURPOSE: This study focuses on outcome for this group of patients after compartment surgical resection. METHOD: All the advanced buccal-complex cancer patients treated at Narayana Multi-specialty Hospital, India, from March 2009-January 2014 formed the study-group. All these patients underwent compartment surgical resection and adjuvant therapy based on pathology report. Their charts were reviewed to evaluate oncological and functional outcome. The radiological findings were used to classify these tumors into three categories - Category I (low-medial pterygoid), Category II (intermediate-lateral pterygoid and plates) and Category III (high-pterygomaxillary fissure). The statistical analysis was used to correlate outcome (margin control, local control and DFS) between these categories. Results: Total 85 cases had T4b buccal cancer. Fifty-nine (69.4%) patients were alive and disease free at median follow-up of 23.7 months (range 06-56 months). About 21 (24.7%) patients died of disease. Local failure was in 16 (18.8%). Regional failure in 19(22.4%) patients was seen. About five patients were lost to follow up.The local and locoregional control rates were 81 % and 77.6 % respectively. The disease free survival and overall survival were 85% and 84% respectively. All the local recurrences-16 (18.8%) happened at skull base and intra-cranial compartment. 30 patients were classified in category I, 47 patients in category II and 8 patients in category III. 16 (18.8%) patients developed local recurrence, of which 4 were from category III and 10 from category II, only 2 from category I . Of the 80 patients who underwent functional evaluation, 71 had good quality of life. CONCLUSIONS: Compartment surgery concept has potential to improve outcome, all patients should not be put in one group and category I & II have good outcome. The advanced buccal mucosa cancer involving masticator space (T4b): New classification and outcome of newer surgical technique (compartment resection). [ABSTRACT FROM AUTHOR]