Dalla prevenzione alla riabilitazione funzionale del paziente affetto da cancro orale

This paper discusses current approaches in the treatment of oral cancer. MATERIALS AND METHODS. The mainstays of treatment in early stage of oral cancer are either radiotherapy or surgery. Advanced diseases are treated either by surgery with postoperative radiotherapy or by definitive radiotherapy, with surgery as last option if necessary. In recurrent and metastatic disease, chemotherapy is the standard treatment option and is generally used with palliative intent. Surgical treatment of malignant tumours in the oral cavity often results in an unfavourable anatomic situation for prosthodontic rehabilitation. Many of these problems can be, at least partially, solved by the use of endosseous oral implants. RESULTS. Although disease responds well at early stage, the risk of a second primary cancer is high, with a development rate of about 4% per year. For non-metastatic locally advanced disease, there is a relatively high risk of tumour recurrence (locoregionally or at distance), despite the use of post-operative radiotherapy after resection. The prognosis for patients with recurrent /metastatic disease remains poor. Oral rehabilitation needs a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. CONCLUSIONS. At early stage, the goal of the treatment is to maintain a favourable efficacy/toxicity ratio and to reduce the incidence of second primary tumours. The immediate aim of the treatment in advanced stage should be to increase survival, locoregional control and organ preservation and to reduce both the formation of distant metastases and the incidence of severe acute treatment induced toxicities, particularly mucositis. In recurrent and metastatic disease, the goal is to improve response rates to chemotherapy and, wherever possible, to prolong survival without reducing quality of life. The development of endosseous implants and bone grafting has allowed to increase the possibilities of oromandibular reconstruction in patients with oral cancer.