Impact of induction chemotherapy on Resectability in Locally advanced oral cavity Carcinomas

Abstract

Purpose: We aim to assess resectability in patients with locally advanced oral cavity squamous cell carcinomas with induction chemotherapy (ICT). Methods: All stage III-IVB oral squamous cell carcinoma patients with borderline resectable (suspected R1) or unresectable disease (stage IVB, except internal carotid artery encasement or pterygoid plate or skull base involvement) recruited between January 2020 and August 2021 at a tertiary care hospital received 2-3 cycles of ICT (standard TPF regimen) followed by a surgical assessment. The primary aim was to evaluate the proportion of patients that became resectable by ICT. Results: Out of 40 patients, 21 were unresectable (stage IVB disease), and 19 were borderline resectable (stage IVA disease) with doubtful resection margins as per the multi-disciplinary discussion. After chemotherapy, 21 patients became resectable (13 out of 19; and 8 out of 21). Thus, resectability was achieved in 52.5% of patients (32.5% for stage IVA and 20% for stage IVB). The median overall survival (OS) in patients who underwent surgery was 20.5 months (95% CI: 16.95-28.25 months) versus 8.0 months (95% CI: 5.74-13.46 months) in patients who remained unresectable after induction chemotherapy (p=0.0001). Conclusions: In our study, induction chemotherapy leads to improved surgical resection rates with acceptable toxicities in a significant proportion of unresectable locally advanced oral cancers, with improved overall survival significantly.