COMMANDO in Locoregional Recurrence of Oropharyngeal Carcinoma

Squamous cell carcinoma (SCC) may develop from any anatomical subsites in the head and neck region. Chronic tobacco and alcohol consumption together with infection of oncogenic viruses are among wellestablished risk factors for the development of oropharyngeal squamous cell carcinoma (OPSCC). Head and neck SCC are previously known as a disease of the middle age with a strong association with tobacco and alcohol usage due to its synergistic effect. For the past 10 years, the prevalence of human papillomavirus (HPV) associated OPSCC is increasing worldwide. Generally, surgery or radiotherapy (RT) is the treatment of choice for early-stage squamous cell cancers of the head and neck. In comparison, with locally advanced head and neck cancers where surgery followed by adjuvant RT or chemoradiation are opted [1]. Another major predictor is HPV tumour status where both HPV-positive OPSCC and HPV-negative OPSCC have the same management protocol but HPV positivity has better prognosis when treated with chemoradiotherapy. For operable OPSCC, COMMANDO (Combined Mandibulectomy and Neck Dissection Operation) is one of the approaches constituting primary tumour resection, removing a part of the mandible and neck dissection of the affected cervical lymph nodes. The amount of mandible removed is according to the size and location of the lesion. Tracheostomy is also regularly performed prior. Reconstruction is needed to cover the large mucosal defect with free skin graft and plating of the remaining mandible to preserve the function. For recurrent operable disease, salvage surgery is indicated after curative chemoradiotherapy but depends greatly on location, the extension of the disease, and previous treatment [2]. ABSTRACT