Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome
Background: According to the 8th edition of the American Joint Committee on Cancer (AJCC), involvement of the masticator space and infratemporal fossa (ITF) in oral cancers indicates advanced disease (T4b), which is often considered unresectable. Previous studies have shown that the extent of ITF in...
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2025-02-01
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| author | Abhishek Mahajan Ujjwal Agarwal Renuka M. Ashtekar Nivedita Chakrabarty Richa Vaish Vijay Maruti Patil Vanita Noronha Nandini Menon Vasundhara Smriti Jai Prakash Agarwal Sarbani Ghosh-Laskar Anil K. D’Cruz Pankaj Chaturvedi Prathamesh Pai Asawari Patil Munita Bal Swapnil Rane Neha Mittal Kumar Prabhash |
| author_facet | Abhishek Mahajan Ujjwal Agarwal Renuka M. Ashtekar Nivedita Chakrabarty Richa Vaish Vijay Maruti Patil Vanita Noronha Nandini Menon Vasundhara Smriti Jai Prakash Agarwal Sarbani Ghosh-Laskar Anil K. D’Cruz Pankaj Chaturvedi Prathamesh Pai Asawari Patil Munita Bal Swapnil Rane Neha Mittal Kumar Prabhash |
| author_sort | Abhishek Mahajan |
| collection | DOAJ |
| description | Background: According to the 8th edition of the American Joint Committee on Cancer (AJCC), involvement of the masticator space and infratemporal fossa (ITF) in oral cancers indicates advanced disease (T4b), which is often considered unresectable. Previous studies have shown that the extent of ITF involvement influences management and outcomes. Therefore, to optimize management, T4b disease should be subclassified based on ITF involvement. Notably, infranotch disease has a more favorable prognosis compared to supranotch disease. Our study also observed that certain subsets of high anterior retroantral ITF involvement may be operable with favorable clinical outcomes. This study aims to derive a new image-based compartmentalization of high ITF involvement and assess its impact on the management and outcomes of oral head and neck squamous cell carcinoma (HNSCC) patients with high ITF involvement. Materials and Methods: This retrospective observational study included 154 non-metastatic, upfront unresectable locally advanced HNSCC patients who were fit for induction neoadjuvant chemotherapy (NACT). ITF involvement was classified into distinct compartments, and detailed staging of the primary tumor (T) and regional nodes (Ns) was performed. Clinical data, including patient demographics, treatment received, and follow-up notes, were documented. Prognosis was assessed using survival metrics: event-free survival (EFS), progression-free survival (PFS), and overall survival (OS). The ITF was categorized into the following compartments: compartment 1 (low ITF: medial pterygoid), compartment 2 (anterior high ITF: retroantral fat), compartment 3 (posterior high ITF), including 3a (paramandibular compartment: paramandibular fat/temporalis), 3b (muscle compartment: lateral pterygoid), and 3c (Perineural compartment: pterygopalatine fossa and pterygomaxillary fissure). Results: Of the 154 cases, 142 (92%) were classified as T4b, with 63 (40.9%) having high ITF involvement and 79 (55.6%) having low ITF involvement. Twelve cases had T4a disease, which was deemed unresectable due to extensive nodal involvement. Subcompartmentalization of the 63 high ITF cases revealed 26 (41.2%) with compartment 2 involvement, 17 (26.9%) with compartment 3a involvement, 11 (17.4%) with compartment 3b involvement, and 9 (14%) with compartment 3c involvement. Disease progression following NACT was significantly higher in compartment 3c, which showed a poor response (<i>p</i> = 0.007). Univariate analysis for PFS revealed similar outcomes for compartments 1 and 2 (<i>p</i> = 0.692), while compartment 3 demonstrated poorer outcomes (<i>p</i> = 0.033). Among thosehigh ITF involvement, compartment 3c had the worst PFS outcome (<i>p</i> = 0.03). Conclusions: Baseline imaging plays a critical role in guiding individualized treatment and predicting clinical outcomes. Low ITF involvement and disease limited to the high retroantral fat compartment exhibit similar clinical outcomes. Among the posterior high ITF compartments, involvement of the pterygopalatine fossa and pterygomaxillary fissure (compartment 3c) is associated with the worst prognosis and poor response to chemotherapy. Subcompartmentalization of ITF involvement provides valuable prognostic information to tailor treatment strategies. |
| format | Article |
| id | doaj-art-672306fd722f428ba50e5e3820663d5e |
| institution | DOAJ |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj-art-672306fd722f428ba50e5e3820663d5e2025-08-20T03:12:02ZengMDPI AGCurrent Oncology1198-00521718-77292025-02-013229910.3390/curroncol32020099Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical OutcomeAbhishek Mahajan0Ujjwal Agarwal1Renuka M. Ashtekar2Nivedita Chakrabarty3Richa Vaish4Vijay Maruti Patil5Vanita Noronha6Nandini Menon7Vasundhara Smriti8Jai Prakash Agarwal9Sarbani Ghosh-Laskar10Anil K. D’Cruz11Pankaj Chaturvedi12Prathamesh Pai13Asawari Patil14Munita Bal15Swapnil Rane16Neha Mittal17Kumar Prabhash18Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool L7 8YA, UKDepartment of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, IndiaDepartment of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, IndiaTata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, IndiaDepartment of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, IndiaDepartment of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaDepartment of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400094, IndiaBackground: According to the 8th edition of the American Joint Committee on Cancer (AJCC), involvement of the masticator space and infratemporal fossa (ITF) in oral cancers indicates advanced disease (T4b), which is often considered unresectable. Previous studies have shown that the extent of ITF involvement influences management and outcomes. Therefore, to optimize management, T4b disease should be subclassified based on ITF involvement. Notably, infranotch disease has a more favorable prognosis compared to supranotch disease. Our study also observed that certain subsets of high anterior retroantral ITF involvement may be operable with favorable clinical outcomes. This study aims to derive a new image-based compartmentalization of high ITF involvement and assess its impact on the management and outcomes of oral head and neck squamous cell carcinoma (HNSCC) patients with high ITF involvement. Materials and Methods: This retrospective observational study included 154 non-metastatic, upfront unresectable locally advanced HNSCC patients who were fit for induction neoadjuvant chemotherapy (NACT). ITF involvement was classified into distinct compartments, and detailed staging of the primary tumor (T) and regional nodes (Ns) was performed. Clinical data, including patient demographics, treatment received, and follow-up notes, were documented. Prognosis was assessed using survival metrics: event-free survival (EFS), progression-free survival (PFS), and overall survival (OS). The ITF was categorized into the following compartments: compartment 1 (low ITF: medial pterygoid), compartment 2 (anterior high ITF: retroantral fat), compartment 3 (posterior high ITF), including 3a (paramandibular compartment: paramandibular fat/temporalis), 3b (muscle compartment: lateral pterygoid), and 3c (Perineural compartment: pterygopalatine fossa and pterygomaxillary fissure). Results: Of the 154 cases, 142 (92%) were classified as T4b, with 63 (40.9%) having high ITF involvement and 79 (55.6%) having low ITF involvement. Twelve cases had T4a disease, which was deemed unresectable due to extensive nodal involvement. Subcompartmentalization of the 63 high ITF cases revealed 26 (41.2%) with compartment 2 involvement, 17 (26.9%) with compartment 3a involvement, 11 (17.4%) with compartment 3b involvement, and 9 (14%) with compartment 3c involvement. Disease progression following NACT was significantly higher in compartment 3c, which showed a poor response (<i>p</i> = 0.007). Univariate analysis for PFS revealed similar outcomes for compartments 1 and 2 (<i>p</i> = 0.692), while compartment 3 demonstrated poorer outcomes (<i>p</i> = 0.033). Among thosehigh ITF involvement, compartment 3c had the worst PFS outcome (<i>p</i> = 0.03). Conclusions: Baseline imaging plays a critical role in guiding individualized treatment and predicting clinical outcomes. Low ITF involvement and disease limited to the high retroantral fat compartment exhibit similar clinical outcomes. Among the posterior high ITF compartments, involvement of the pterygopalatine fossa and pterygomaxillary fissure (compartment 3c) is associated with the worst prognosis and poor response to chemotherapy. Subcompartmentalization of ITF involvement provides valuable prognostic information to tailor treatment strategies.https://www.mdpi.com/1718-7729/32/2/99HNSCCoral cancerCTimaginginfratemporal fossaAJCC 8th |
| spellingShingle | Abhishek Mahajan Ujjwal Agarwal Renuka M. Ashtekar Nivedita Chakrabarty Richa Vaish Vijay Maruti Patil Vanita Noronha Nandini Menon Vasundhara Smriti Jai Prakash Agarwal Sarbani Ghosh-Laskar Anil K. D’Cruz Pankaj Chaturvedi Prathamesh Pai Asawari Patil Munita Bal Swapnil Rane Neha Mittal Kumar Prabhash Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome Current Oncology HNSCC oral cancer CT imaging infratemporal fossa AJCC 8th |
| title | Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome |
| title_full | Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome |
| title_fullStr | Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome |
| title_full_unstemmed | Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome |
| title_short | Compartmentalization of High Infratemporal Fossa in Oral Cavity Squamous Cell Carcinomas and Its Impact on Clinical Outcome |
| title_sort | compartmentalization of high infratemporal fossa in oral cavity squamous cell carcinomas and its impact on clinical outcome |
| topic | HNSCC oral cancer CT imaging infratemporal fossa AJCC 8th |
| url | https://www.mdpi.com/1718-7729/32/2/99 |
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