Induction chemotherapy for stage III/IV oral and oropharyngeal squamous cell cancers.

Abstract

e16012 Background: There is limited data on the role of induction chemotherapy (IC) in the treatment of advanced oral and oropharyngeal squamous cell carcinoma (OSCC). We present our experience using IC followed by definitive treatment with surgery, CRT or their combination, in the management of stage III/ IV OSCC. Methods: Total of 42 OSCC patients [22 oral cavity (OC) and 20 oropharyngeal (OP)] were included in the study. Six patients had stage III and 36 had stage IV disease. Median age was 59 years with 36% females. Patients were treated with a median of 2 cycles of cisplatin based IC (range: 2 to 4) on a weekly or every 3 week basis. Response to IC was determined clinically and radiologically. Patients with no residual disease were considered to have complete response (CR), >80% response were classified as near complete response (NCR), <80% response as partial response (PR) and no change was considered as no response (NR). Results: Among the 22 OC patients, 2 had CR, 7 had NCR, 8 had PR and 5 had NR to IC. Among the 20 OP patients, 2 had CR, 7 had NCR, 10 had PR and 1 had NR. (a) Complete responders: All 4 CR patients underwent definitive surgery with pathologic CR and remain disease free (mean follow-up:24.2 months); (b) Near complete responders: Of the 14 NCR patients, 1 OP developed local recurrence in 13 months; rest remain disease-free; (c) Partial Responders: Among the 8 OC -PR patients, 2 developed local recurrence and 2 distant disease, 4 patients remained disease free (mean follow-up:19.5 months). Among the 10 OP- PR patients, 5 developed locoregional recurrence and 4 remained disease free (mean follow-up:16.7 months). One patient died of metastatic disease before definitive treatment. (d) Non responders: Among the 5 OC – NR patients, 1 had local recurrence, 2 had distant metastasis and 2 remained disease free for average of 9 months. The OP – NR patient remained disease free for 2 months after definitive therapy. There was a significant difference between disease free survival of OP and OC CR/NCR versus PR/NR (p=0.007). Overall, 43% had CR/NCR while 43% had PR and 14%NR. Conclusions: IC is effective and well-tolerated neo-adjuvant therapy for OSCC. Responders to IC had longer disease-free survival compared to non-responders. No significant financial relationships to disclose.