Neoadjuvant chemotherapy: role in locoregionally advanced oral cancers

Abstract

Background: Oral cancers are the most predominant cancers in our region due to the habit of betel nut chewing. The treatment protocols available have not given satisfactory results. Neoadjuvant chemotherapy has been tried out successfully in other cancers like cancer of larynx. Objectives: Our study aimed to assess the response of neoadjuvant chemotherapy in locally advanced oral cancer. Materials and Methods: A total of 40 patients were taken up for the study; 20 patients each in both study and the control groups. In the study group, patients were subjected to three cycles of neoadjuvant chemotherapy (cisplatin and 5-fluorouracil) after doing relevant investigations, later evaluated for resectability, and later taken up for surgery or radiotherapy depending on the response. In the control arm, all the patients were directly taken up for surgery. Results: The results showed that among the 20 patients who underwent neoadjuvant chemotherapy no one had complete response, 55% had partial response, 35% had stable disease, and 2 had progressive disease and were advised palliative radiotherapy only. Two patients in study arm were lost for follow-up. The remaining 16 patients in study arm and all 20 patients in control arm were taken up for surgery. The specimens were assessed histopathologically for positive margins. Almost equal incidence of positive margins was found in both arms. The patients were followed up for 2 years after surgery. The results showed marginally better disease-free survival in stage III disease patients who underwent neoadjuvant chemotherapy followed by surgery compared to those who had direct surgery; however, no major difference in patient with stage IVA disease was seen. Conclusion: Neoadjuvant chemotherapy in locally advanced oral cancers delays the progression of disease and gives partial response macroscopically. There was no significant improvement in locoregional control, disease-free survival, and overall survival of the patients.