The effect of preoperative induction chemotherapy on long-term survival of patients with advanced squamous cell carcinoma of the oral cavity tongue

Abstract

Objective:To discuss the long term efficency of preoperative induction chemotherapy(IC)±radiotherapy on patients with resectable stage Ⅲ or Ⅳ squamous cell carcinoma of the oral cavity tongue(SCCOT).Method:During June 1996 to December 2005, 73 patients with locally advanced SCCOT treated preoperatively with IC(3 cycle of cisplatin and 5 fluorouracil) followed by surgery(resection of the primary tumor and neck)±radiotherapy in the Cancer Center of Sun Yat-sen University were enrolled in our study. Five-year overall survival rates(OS), local control rate and reasons of treatment failure were analyzed retrospectively.Result:The follow-up time was 1.9 to 188.0 months, and the median follow-up time was 70.9 months.Among that, 24 cases(32.9%) were still alive, of which 23 patients survival time is more than 10 years until the deadline of the follow-up. After IC, 17 patients(23.3%) had clinical complete response; 44 patients(60.3%) had a clinical partial response; 12 patients(16.4%) had no response or progression, and an overall response rate was 83.6%(65/73). On final surgical pathology, 14 patients(19.2%) had pathological complete response; 59 patients(80.8%) had histological incomplete response(residual tumor). Univariate analysis showed that the tumor size(P< 0.05), cervical lymphatic metastasis(P< 0.05),clinical stage(P< 0.05), the different clinical remissions(P< 0.05), had or not pathological complete remission(P< 0.05) were risk factors affecting prognosis(P< 0.05).Multivariate analysis indicated that cervical lymphatic metastasis cervical lymphatic metastasis(P< 0.05), the different clinical remissions (P< 0.05), had or not pathological complete remission(P< 0.05) were independent factors for prognosis. Five-year OS of clinical effective of IC was 62.5%, apparently higher than the invalid effect 41.7% (P< 0.05). Five-year OS of pCR was 92.9%, while have no pCR was 47.9%(P< 0.05). A significant difference between the two groups was also found. During whole follow-up time, 22 patients developed recurrence. Five-year OS was 59.8%, local control rate were 69.9%.Conclusion:IC plus surgery with or without postoperative radiotherapy was a treatment modality that was tolerated with encouraging activity and survival outcome in patients with advanced resectable SCCOT. Response rate with this IC regimen was limited, but the responders were associated with excellent prognosis.