Abstract 914P
Background
In developing countries, most OSCCs present as locally advanced disease often deemed unresectable or borderline resectable, in which ICT can improve the probability of margin-free resections. However previous studies report conflicting data regarding its usefulness.
Methods
This prospective study included ECOG 0-1 OSCC patients with borderline resectable (suspected R1) or unresectable disease (stage IVB, except internal carotid artery encasement or pterygoid plate or skull base involvement). Patients received 2-3 cycles of ICT (docetaxel 75mg/m2 D1, cisplatin 75 mg/m2 D1, 5-fluorouracil 750mg/m2 D1-D5, q3weekly) with filgrastim support followed by surgical assessment. Adjuvant radiotherapy was given. Unresectable patients underwent (chemo) radiotherapy (CRT) or palliation. The primary aim was to evaluate the proportion of patients that became resectable by ICT.
Results
Between January and December 2020, 25 patients were recruited. Baseline characteristics are detailed in table. Median number of chemotherapy cycles was two. Acute toxicities: anaemia (80%, 76% grade 1), neutropenia (40% grade 1), diarrhoea (52%), vomiting (36%), neuropathy (20%). The incidence of any grade 3-4 toxicity was 4%. Eleven patients underwent surgery. Pathological details: ypT (T2:T3:T4a 1:1:9), ypN (N0:N1:N2:N3 5:3:2:1), yp overall stage (II:III:IVA:IVB 1:1:8:1), median (IQR) lymph nodes harvested 25 (20-37), margins (close:free 1:10), extranodal extension 12%, LVSI 12%, PNI 16%. All resected patients completed adjuvant radiotherapy. Out of 14 patients deemed non-resectable, one underwent definitive CRT, and the rest were shifted to palliation. Table: 914P
| Particulars | Number | Percentage |
| Gender | ||
| Male | 24 | 96 |
| Female | 1 | 4 |
| Age in years, median(IQR) | 39(31.5-51.5) | |
| Location of primary | ||
| Tongue | 1 | 4 |
| Buccal mucosa | 20 | 80 |
| Gingiva | 4 | 16 |
| Differentiation | ||
| Well-differentiated | 17 | 68 |
| Moderately differentiated | 8 | 32 |
| Poorly differentiated | 0 | 0 |
| Clinical T stage | ||
| T3 | 1 | 4 |
| T4a | 15 | 60 |
| T4b | 9 | 36 |
| Clinical N stage | ||
| N0 | 3 | 12 |
| N1 | 12 | 48 |
| N2 | 3 | 12 |
| N3 | 7 | 28 |
| Overall stage | ||
| III | 1 | 4 |
| IVA | 12 | 48 |
| IVB | 12 | 48 |
| Tobacco usage | ||
| Yes | 24 | 96 |
| No | 1 | 4 |
| Alcohol usage | ||
| Yes | 6 | 24 |
| No | 19 | 76 |
| ECOG | ||
| 0 | 7 | 28 |
| 1 | 18 | 72 |
| Grade of trismus | ||
| 0 | 4 | 16 |
| 1 | 5 | 20 |
| 2 | 6 | 24 |
| 3 | 10 | 40 |
| Masticator space involvement | ||
| Yes | 9 | 36 |
| No | 16 | 64 |
| Low infratemporal fossa involvement | ||
| Yes | 9 | 36 |
| No | 16 | 64 |
Conclusions
Induction chemotherapy when given in well-selected borderline resectable and unresectable oral cancers leads to improved surgical resection rates with acceptable toxicities. This can potentially improve long-term locoregional control, which will be determined on adequate follow-up.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.