Impact of Induction Chemotherapy on Nodal and Distal Disease Control in Locally Advanced Buccal Mucosa Cancer

Abstract

Background: Buccal mucosa squamous cell cancer is the most common cancer in India. Majority of them presenting in advanced stage whose prognosis after surgery depends significantly upon the regional and distal spread. We studied the impact of neoadjuvant chemotherapy (NACT) on nodal and distal control of disease in operated cases of advanced buccal mucosa cancer. Aim: A retrospective study to evaluate the impact of induction chemotherapy (NACT) on nodal and distal failure in locally advanced buccal mucosa cancer. Methods: A total of 224 patients of advanced buccal mucosal cancer who underwent surgery between 2014 and 2015 were evaluated retrospectively with a follow-up of two years. Total 111 of the above had received NACT prior to surgery while 113 patients underwent upfront surgery. The CT scans and histologic reports were then compared for evaluation and analysis. Results: Among patients with T4a disease, 45.85% in upfront surgery group compared with 54% in NACT group showed metastatic pathologic nodes, while in T4b patients, the rates were 83.33% compared with 49.18% respectively. In patients with clinical/radiologic positive neck nodes at presentation, 87.5% in upfront surgery group as compared with 55.55% in NACT group showed metastatic nodes in histopathologic evaluation. 13.27% patients in the upfront surgery group had nodal and/or distal failure in the two years follow-up, whereas only 3.6% patients in the NACT group. 25% patients with peri-nodal extension in upfront surgery group showed nodal and/or distal failure, while only 6% in NACT group. The results in different nodal-ratio strata was evaluated. It showed that NACT has equal failure rate as in upfront group in nodal-ratio > 50, which is considered as very advanced and aggressive tumor. But in patients with nodal-ratio < 50, NACT group showed lesser failure rate than upfront group. Conclusion: We show regressional effect of NACT on nodal metastases. This study also shows NACT to be having a significantly positive impact on nodal and distal control. Hence role of induction chemotherapy needs to be considered in advanced cases of buccal mucosa cancer with nodal metastases.