Neo adjuvant chemotherapy in locally advanced oral cancers -A prospective study at a tertiary cancer care hospital

Abstract

Oral squamous cell carcinoma (OSCC) is the most prevalent type of cancer found in the oral cavity. Approximately 30% of these tumours are detected at an early stage, while the majority are diagnosed as locally advanced tumours. Extensive research has been conducted on neoadjuvant chemotherapy (NACT) in head and neck cancers, aiming to reduce surgical margins, decrease distant metastasis rates, and improve overall outcomes. In this prospective study conducted at the Department of surgical oncology, Tirunelveli Medical College, 60 patients with unresectable locally advanced oral cancers were staged based on the AJCC TNM (8th edition). The period of study was from October 2018 to March 2023. Here the selected patients are examined both clinically and radiologically, measurements of the target lesions are made. These patients are subjected to neoadjuvant chemotherapy (TPF regimen) upto three cycles based on the clinical response after each cycle. reassessment done prior to surgery as done during the prechemotherapy. Adjuvant therapy post-surgery is based on the histopathology. Among the 60 patients enrolled in this study, 33 of 60 (55.0 %) were males and 27 of 60 (45%) were females. Based on age distribution 8.3% of patients were less the 40 years of age, 41.7% were between 51 to 60 years. The common risk factors were tobacco / pan chewing in 66.7% of patients, smoking in 40% of patients and alcoholism in 38.3% of patients. All the 60 patients received TPF regimen as a neo-adjuvant chemotherapy for two or three cycles and the clinical responses were recorded after NACT prior to definitive therapy (surgery vs RT. The mean and median of survival was calculated in 33 patients who had completed treatment by 2021 in view of the follow up period of at least for 24 months were mandatory to analyse the treatment outcome and disease free survival. The overall survival in surgery group was 35.1 months and RT group was 21.8 months. The disease free survival in surgery group was 28 months whereas in RT group was 16 months.Patients who have oral cavity cancers that cannot be surgically amenable up-front may experience a response rate of approximately 25% when treated with an aggressive three-drug regimen (TPF) and these patients may derive benefits from subsequent surgical treatment.