
==== Front
Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

38857518
IJS-D-24-01000
10.1097/JS9.0000000000001782
00002
3
Editorials
Navigating ablation treatment side effects in oral cancer: a call for informed patient care
Prasad Monisha MSc, MPhil, PhD amonishaprasad.smc@saveetha.com

Karobari Mohmed Isaqali BDS, MSc, MFDS. RCPS(Galsg), PhD dr.isaq@gmail.com
ab*
a Department of Dental Research, Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
b Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
* Corresponding author. Address: Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh 12211, Cambodia. E-mail: dr.isaq@gmail.com (M.I. Karobari).
9 2024
10 6 2024
110 9 53205322
19 3 2024
30 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmcOral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer and represents a significant medical burden worldwide1. Surgery, chemotherapy, immunotherapy, radiation treatments, and ablation are general therapeutic arsenal against oral cancer. Chemotherapy possesses inherent toxicity and lacks curative potential on its own. Even when combined with radiotherapy in an alternating regimen, it proves ineffective in preventing persistent or recurrent disease2. While these interventions hold promise in addressing the disease, patients and healthcare providers alike must acknowledge and navigate the potential side effects associated with these treatments. Among the diverse arsenal of treatments available, ablation therapies have emerged as pivotal tools in the fight against this complex disease. While these therapies hold significant promise, it is imperative to shed light on the often-overlooked aspect of their aftermath – the potential side effects3.

One of the most immediate concerns in post-ablations is the management of pain. As patients embark on the journey of recovery, healthcare teams must provide effective pain management strategies tailored to individual needs. Open communication channels between patients and providers are essential to address pain promptly, ensuring a more comfortable recovery process. Ablation treatments may impact essential functions such as swallowing, eating, and speech. In recognizing these potential challenges, a comprehensive approach to rehabilitation becomes paramount4. Speech therapy and targeted interventions can significantly contribute to restoring function and improving the quality of life for patients navigating these hurdles.

The impact of ablative procedures on taste buds and sensory perceptions is an area that warrants attention. Taste changes can occur in patients, so it is important to have a sophisticated awareness of these changes and take proactive steps to address the issues5. Dietary adjustments and nutritional support may play a pivotal role in ensuring patients maintain adequate nutrition during their recovery. As with any surgical procedure, there is a risk of infection and bleeding following ablation treatments. An attentive postoperative care strategy, including prophylactic antibiotics and close monitoring, can mitigate these risks. Patients are encouraged to report any signs of infection or excessive bleeding to their healthcare providers. It is critical to recognize the emotional and psychological toll that a cancer diagnosis and treatment can take in addition to the physical effects. The integration of holistic support services, such as counseling and support groups, can provide patients with the emotional resilience needed to navigate the challenges of oral cancer treatment.

Ablation treatments stand as powerful tools in the fight against oral cancer, offering hope for improved outcomes and enhanced quality of life6. However, a comprehensive understanding of potential side effects and a patient-centered approach to care are vital components of a successful treatment journey. By fostering open communication, embracing rehabilitation strategies, and providing holistic support, we can empower individuals facing oral cancer to navigate the complexities of ablation treatments with resilience and optimism. Together, we can move toward a future where effective treatment is coupled with compassionate and informed care7.

Laser ablation surgery emerges as a potent intervention to reduce tumor burden in oral cancer patients facing inoperable conditions. In a study led by Bhalla et al.3, it was found that performing repeated laser ablations weekly for 3 months led to a significant improvement in post-treatment speech. Swelling exhibited a gradual reduction within 2 months; even with these encouraging results, the patient survived for 11 months following the procedure before ultimately succumbing to unmanageable multiple local recurrences8,9. Wei et al. 10 employed ultrasound-guided microwave ablation (MWA) as a treatment method for lower lip squamous cell carcinoma (SCC) and metastatic lymph nodes. They utilized a rigid slit needle microwave antenna with a diameter of 1.6 mm, enabling deep tissue penetration. Five days post-ablation, a light brown scab formed in the treated area, and after 15 days, the ablation zone naturally fell off. Within one month, mucosa covered the wound, demonstrating successful recovery post-ablation. MWA, characterized by higher ablation temperatures in a shorter duration and reduced susceptibility to the heat sink effect, is deemed suitable for patients unwilling or unable to undergo open surgery. However, it is crucial to acknowledge potential risks during the MWA process, such as inadvertent damage to critical structures in the lip and adjacent areas, leading to postoperative complications like dysphagia, slurred speech, and skin burns. To mitigate these complications, the researchers generously applied an ice disinfectant coupler to the tumor’s surface and covered it with a sterilized ultrasound pad. Validation of the efficacy and safety of this treatment approach requires extensive multi-center and large-sample studies.

In a study conducted by Hsieh9, participants were divided into two groups: one undergoing tumor ablation with free flap reconstruction and the other undergoing tumor ablation without free flap reconstruction. All patients received radical surgery, with or without free flap reconstruction, as needed for addressing large defects resulting from tumor ablation. The primary goal of surgical resection at the tumor site was to achieve a minimum microscopic margin of 10 mm of normal tissue clearance beyond the tumor, as determined by frozen section analysis. The study’s conclusion indicated that while free flap reconstruction did not contribute to a prolonged life expectancy, it did enhance the overall quality of life. Factors such as good general physical health, the absence of pain, and the ability to eat were associated with improved survival. Free flap reconstruction was found to positively impact the quality of life, indirectly influencing survival. Additionally, it enabled more patients to undergo tumor ablation rather than resorting to palliative treatment. Despite the presence of adverse prognostic factors in patients with free flap reconstruction, the study observed that both patient survival and cancer recurrence rates were comparable to those without free flap reconstruction.

The delicate balance between progress and challenges in ablation treatment necessitates a comprehensive understanding of the potential adverse effects to ensure the overall well-being of patients undergoing these procedures. Future prospective efforts should focus on refining existing ablation techniques to minimize adverse effects, enhance precision, and optimize patient outcomes. Additionally, advancements in the development of novel technologies and treatment modalities may contribute to further reducing side effects while maintaining or improving the effectiveness of ablation therapies (Fig. 1). Moreover, interdisciplinary collaboration between oncologists, surgeons, radiologists, and researchers is crucial to fostering a holistic approach to oral cancer treatment. This partnership may result in a combination of alternative medicines, along with improved awareness of patient-specific aspects such as personalized treatment plans and susceptibility to side effects. As we move forward, the incorporation of cutting-edge technologies, such as artificial intelligence and targeted drug delivery systems, holds promise for refining ablation treatments and addressing specific challenges associated with oral cancer. By embracing a patient-centered approach, where individualized treatment strategies consider both the disease characteristics and the unique profile of each patient, we can strive to strike an optimal balance between progress and challenges in the realm of ablation treatment for oral cancer. Ultimately, the goal is to improve therapeutic outcomes, enhance patient quality of life, and contribute to the broader advancement of cancer care.

Figure 1 This diagram provides an overview of the major side effects associated with ablative therapies, including laser, microwave, and radiofrequency ablation.

Ethical approval

Not applicable.

Consent

Not applicable.

Source of funding

Not applicable.

Author contribution

Both the authors contributed to the work reported, whether that is in the conception, data analysis, or in all these areas; took part in drafting, revising, or critically reviewing the article; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Conflicts of interest disclosure

The authors declare that they have no conflicts of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Mohmed Isaqali Karobari.

Data availability statement

Not applicable.

Provenance and peer review

Confirmed.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 10 June 2024
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References

1 Tan Y Wang Z Xu M . Oral squamous cell carcinomas: state of the field and emerging directions. Int J Oral Sci 2023;15 :44.37736748
2 Mali SB Dahivelkar S . Photodynamic therapy for cancer. Oral Oncol Rep 2024;9 :100129.
3 Bhalla R Bhalla S Kapadia A . Palliative management of unresectable oral carcinoma by laser ablation and chemotherapy-case report. J Cancer Sci Clin Ther 2022;6 :32–38.
4 Gómez FM Aguado A Barnacle AM . Opportunities for interventional radiology in paediatric oncology. EJC Paediatr Oncol 2024;3 :100139.
5 Chen WL Wang YY Zhou B . Survival and functional outcomes of patients who underwent facial-submental artery island flap reconstruction after oral cavity or HPV-negative oropharyngeal squamous cell carcinoma ablation. J Stomatol Oral Maxillofac Surg 2020;121 :383–389.31783189
6 Klibngern H Ariyanon T Ruenmarkkaew D . Submental island flap versus supraclavicular island flap in oral tongue cancer reconstruction: perioperative and functional outcomes. J Stomatol Oral Maxillofac Surg 2024;125 :101789.38281700
7 Yang J Guo W Huang R . Ultrasound-guided microwave ablation in the treatment of early-stage tongue cancer. Front Oncol 2022;12 :950228.36110931
8 Knavel EM Brace CL . Tumor ablation: common modalities and general practices. Tech Vasc Interv Radiol 2013;16 :192–200.24238374
9 Hsieh TY Chang KP Lee SS . Free flap reconstruction in patients with advanced oral squamous cell carcinoma: analysis of patient survival and cancer recurrence. Microsurgery 2012;32 :598–604.22903315
10 Wei T Lu M Wang L . Ultrasound-guided microwave ablation for treatment of lip cancer. J Cancer Res Ther 2023;19 :1685–1688.38156939
