OP048: Induction chemotherapy in unresectable oral cavity cancers

Abstract

To study the safety and impact of induction chemotherapy in unresectable T4b oral cavity cancers. We report a retrospective analysis of patients with T4b oral cavity cancers treated with induction chemotherapy, either 3-drug combination of cisplatin, 5 FU and docetaxel or a 2-drug combination of platinum and taxane. Radiological response and feasibility for resection were reassessed after chemotherapy in a multidisciplinary clinic. Local treatment was surgical excision or radical chemoradiation. The primary objectives were the achievement of resectability and impact of surgery on overall survival. 110 patients with oral cavity tumours received induction chemotherapy. The tumour was staged as T4b due to involvement of masticator space in 102 patients and pterygoid plates in the rest. Twenty-one patients received 3-drug regimen and the rest 2-drug regimen. Docetaxel was used in 40 patients. The radiological response was PR in 28, stable disease in 49 and progression in 23 patients. The primary objective of surgical resectability was achieved in 34 patients. On multivariate analysis, independent predictors of achieving resectability were use of 3 drug regimens and use of docetaxel. Toxicities were manageable with febrile neutropenia in 14 patients (12.72%) and grades 3–4 GI toxicity in 13 patients (11.1%). The patients who were successfully resected after NACT had a statistically significant improvement in overall survival (median survival 7.5 months versus not reached). Induction chemotherapy is safe and can achieve resectability in some patients with T4b tumours. Patients undergoing resection had improved overall survival in our study.