Induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers: A regional cancer center experience

Rudresha, A.H.; Chaudhuri, Tamojit; Lakshmaiah, K C; Babu, K Govind; Dasappa, Lokanatha; Jacob, LA; Babu, M C Suresh; Lokesh, K.; Rajeev, L K

doi:10.4103/ijc.ijc_131_17

Cited by 12 publications

(23 citation statements)

References 23 publications

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“…In our study, the use of triple agent induction therapy was 13.5%. Though it was comparable to other contemporary literature, 20,21 it still was very less. The major barrier of triple therapy was the need for inpatient admission for continuous 5FU infusion and concern about increased side effects.…”

Section: Triple Agent Versus Dual Agentsupporting

confidence: 76%

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

et al. 2021

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Objective/Hypothesis: With non-surgical treatment, T4b oral squamous cell carcinoma (OSCC) have an unacceptably poor prognosis. A subset of patients if selected wisely for surgery, can have significantly improved survival. The present study aims to explore the feasibility of radical resection and neoadjuvant chemotherapy (NACT) in the T4b OSCC and their impact on survival, along with the factors affecting it.Study Design: This is a retrospective analysis of 302 consecutive patients with T4b OSCC presented at our institute between July 2015 and January 2016.Methods: Three different treatment protocols were decided depending on the extent of the disease-upfront resection, NACT (followed by surgery or chemo/radiation depending on the response), or upfront non-surgical treatment (chemotherapy and/or radiotherapy).Results: Upfront surgery was done in 67 (22.19%) patients and 155 (51.32%) patients received NACT. The rest of the patients received upfront non-surgical treatment. The overall response rate of NACT was 23.23% and the resectability rate was 36.13%. The median OS for the whole population was 12 months (30 months for the surgical group and 9 months for the non-surgical group). There was no survival difference between supra versus infra-notch tumors (P value = .552) or post-NACT versus upfront surgery (P value = .932). Nodal involvement was the most important poor prognostic factor affecting both DFS (P = .006) and OS (P = .002).Conclusions: With proper patient selection after thorough clinico-radiological assessment, a subset of T4b OSCC can be operated with curative intention; either upfront or after downstaging with NACT, which ultimately translates into improved survival.

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Section: Triple Agent Versus Dual Agentsupporting

confidence: 76%

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

et al. 2021

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“…Treatment was similar to the other T4b study by the same group. 43 The observed pCR rate was 21.3% and resectability rate after ICT was 23.8%. Median OS was again better for patients who had surgical resection and adjuvant RT compared to a patient who had no resection (16.9 vs 8.8 months, respectively, P ¼ .000).…”

Section: Induction Chemotherapy Followed By Surgical Resection With or Without Adjuvant Rtmentioning

confidence: 86%

Locally Advanced Oral Cavity Cancers: What Is The Optimal Care?

et al. 2020

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Patients with oral cavity cancers often present late to seek medical care. Surgery is usually the preferred upfront treatment. However, surgical resection cannot be achieved in many cases with advanced disease without major impact on patient’s quality of life. On the other hand, radiotherapy (RT) and chemotherapy (CT) have not been employed routinely to replace surgery as curative treatment or to facilitate surgery as neoadjuvant therapy. The optimal care of these patients is challenging when surgical treatment is not feasible. In this review, we aimed to summarize the best available evidence-based treatment approaches for patients with locally advanced oral cavity cancer. Surgery followed by RT with or without CT is the standard of care for locally advanced oral cavity squamous cell carcinoma. In the case of unresectable disease, induction CT prior to surgery or chemoradiotherapy (CRT) can be attempted with curative intent. For inoperable patients or when surgery is expected to result in poor functional outcome, patients may be candidates for possibly curative CRT or palliative RT with a focus on quality of life.

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“…All selected studies were published in English language between 2011 and 2020. There were 15 retrospective cohort studies, 22,[24][25][26]28,34,[36][37][38][39][40][41][42]47,50 eight were prospective cohort studies, 19,23,29,32,33,35,44,46 six were RCTs, 18,21,27,30,31,43 four were clinical trials, 20,45,48,49 and none was case-control study. The sample size varied from 16 27 to 976 42 participants.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The sample size varied from 16 27 to 976 42 participants. There were eight studies from India, 19,21,34,[36][37][38]43,46 six from Japan, 26,27,32,33,40,45 four from Taiwan, 20,42,47,48 three from the United States, 25,35,41 two from China, 30,31 two from Pakistan, 28,49 while the other studies were one from each of the following: Canada, 50 Hungary, 44 Italy, 23 Iran, 29 Spain, 39 The Netherlands, 24 Thailand, 22 and Ukraine. 18 Only 14 studies 20,22,24,26,28,[34][35][36][37][38][41][42][43]46 reported oral cancer risk factors, such as smoking, alcohol consumption and betel chewing.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Twenty-seven studies 18,19,[21][22][23][24][25][26][27][28][29][32][33][34][35][36][37][38][39][40][41][42][44][45][46]49,50 assessed different therapies that in some way combined the use of CT and RT, three studies 42,43,50 evaluated RT alone, two studies 31,47 assessed CT alone, four studies 20,31,43,48 examined the combination of targeted therapy plus CT or RT, and only one study for each of the interventions of immunotherapy 21 and gene therapy. 30 The main outcomes reported were overall survival (OS), locoregional control (LRC), progression-free survival (PFS), disease-free survival (DFS), complete response (CR), and cancer-specific survival (CSS).…”

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confidence: 99%

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Therapeutic Options in Unresectable Oral Squamous Cell Carcinoma: A Systematic Review

Anaya¹,

Amador²,

Acosta³

2021

CMAR

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Purpose This review describes the current scientific evidence of therapeutic options in unresectable oral squamous cell carcinoma. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched MEDLINE (Via PubMed) to identify studies assessing treatments for unresectable oral squamous cell carcinoma. The methodological quality assessment of the included studies was performed using the Joanna Briggs Institute (JBI) checklist tool. The evidence was organized and presented using tables and narrative synthesis. Results Thirty-three studies met the eligibility criteria. Most studies had an observational design. The sample size varied from 16 to 916 participants. The methodology quality of the included studies ranged from 2.5 to 10 using the JBI tool. Overall, the optimal treatment of patients with unresectable oral cancer is challenging, so there is a sprinkling of studies assessing a variety of therapeutic options, such as radiotherapy, chemotherapy, concurrent chemoradiotherapy, immunotherapy, targeted therapy plus chemotherapy or radiotherapy, and gene therapy plus chemotherapy. Conclusion There is lacking evidence about the benefits of some therapeutic options for unresectable oral squamous cell carcinoma. Overall, these patients can be treated using a multimodal approach such as concurrent chemoradiotherapy or induction chemotherapy followed by chemoradiotherapy, which have shown good clinical outcomes. However, other options could be considered depending on the assessment of risk/benefits, tumor extension, and patient values and preferences.

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Induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers: A regional cancer center experience

Abstract: IC had a manageable toxicity profile and achieved resectability in 19% of our patients with T4b OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment.

Cited by 12 publications

References 23 publications

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

Survival Impact of Surgical Resection in Locally Advanced T4b Oral Squamous Cell Carcinoma

Locally Advanced Oral Cavity Cancers: What Is The Optimal Care?

Therapeutic Options in Unresectable Oral Squamous Cell Carcinoma: A Systematic Review

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