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This paper for tertiary cancer centre in India attempted to determine whether patients with T4b oral cancers involving the 'masticator space' should be treated with survival intent comparable to T4a cancers. Over a 7-year period, 30 patients with T4b cancers were identified and their involvement with the structures within the masticatory space - masseter, medial pterygoid, lateral pterygoid, temporalis, pterygoid plates and ramus of the mandible, with each of these structures given a score of 1. In those patients with three or fewer masticatory structures involved, the survival rate was comparable to T4a tumours after curative surgery followed by radiotherapy. They acknowledged there was a degree of selection bias in that only those patients with a small nodal burden were selected for surgery in the T4b group. They also acknowledge the potential positive effects of neoadjuvant chemotherapy.

Role of structures in the masticator space in selective patients with resectable T4b oral cancer: findings from a survival analysis.
Kumar A, Singh R, Santhosh M, et al.
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Stuart Clark

Manchester Royal Infirmary, Manchester, UK.

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