Comparative Evaluation of Upfront Surgery and Neoadjuvant Chemotherapy Followed by Surgery in Locally Advanced Oral Squamous Cell Carcinoma.

Abstract

Introduction: Oral squamous cell carcinoma with stage T3 and above constitutes locally advanced disease without distant metastasis. Even with multimodality treatment, the 5-year survival is less than 50%. In this retrospective study, we shared our experience from a single center of the utility of neoadjuvant chemotherapy in the outcome of cT4 oral cavity squamous cell carcinoma.

Methods: Patients who underwent surgery either in the form of upfront resection or induction chemotherapy followed by surgery were considered for evaluation. Patients in the induction group underwent three cycles of NACT prior to response assessment. Patients with complete response underwent surgery, and partial responders were given fourth cycle of NACT prior to surgery. Patients with stable disease or disease progression were subjected to nonsurgical therapy. The primary endpoint assessment of the study was overall survival and disease-free survival. Secondary outcomes assessed were the extent of resectability after NACT, frequency of marginal mandibulectomies, postoperative radiotherapy and response following NACT.

Results: A total of 285 patients were initially screened for the review; of which 164 patients (Group A) underwent upfront surgical resection and 121 patients received NACT. The median DFS and OS in our study were 28 months and 30 months, respectively. There was no difference in DFS and OS between upfront surgery and NACT surgery. On subset analysis, NACT improved survival only in T4b patients. Positive margin, nodal metastasis and presence of extracapsular spread were the risk factors effecting survival.

Discussion: Induction chemotherapy improved survival only in T4b patients. There was no difference in survival in T4a patients with the addition of NACT. Overall no difference was seen in survival with the use of induction chemotherapy.