The standard of care for oral squamous cell carcinoma (OSCC) at present, consist of surgical resection followed by adjuvant radiotherapy and chemotherapy as indicated. However, indications of induction chemotherapy (IC) in oral cancers are not clearly defined. This retrospective analysis aimed to investigate the efficacy, toxicity and impact of induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers.
Patients diagnosed with locally advanced T4b OSCC from January 2013 and March 2017 at our centre, who received 2-3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients’ profile, response and toxicity of IC, resectability status and overall survival (OS) were evaluated. Statistical analyses were done by SPSS version 17.0.
Total 134 patients received IC, and out of them 98 (73.1%) were males. Median age at diagnosis was 44 years (range 31-60 years). 107 (79.8%) of our patients received doublet chemotherapy (with paclitaxel + cisplatin), and the rest of the patients received triplet regimen (with paclitaxel/docetaxel + cisplatin + 5-FU). Majority of the patients had buccal mucosa cancers (n = 92), followed by gingivo-buccal sulcus (n = 26) and oral tongue (n = 16) primaries. After IC, partial response was achieved in 25 (18.7%) patients, stable disease in 83 (61.9%) patients and disease progression was noted in 26 (19.4%) patients. Post-induction chemotherapy, resectability was achieved in 28 (21%) of 134 patients, but 8 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 20) was 18.7 months (95% CI: 16.2-21.5 months) and for those treated with non-surgical local therapy (n = 114) was 7.9 months (95% CI: 6.2-9.2 months) (log-rank p = 0.000).
IC may improve the resectability in our patients with T4b OSCC with a manageable toxicity profile. Patients underwent resection had a significantly better median OS than those who received non-surgical local treatment.
Clinical trial identification
Legal entity responsible for the study
Kidwai cancer institute
All authors have declared no conflicts of interest.