Oncological Outcome Following 3-Drug Neo-Adjuvant Chemotherapy Initiated “Triple Regimen” for Selected Subset of cT4b Bucco-Alveolar Carcinoma with Supra-Notch Infratemporal Fossa Extension

Abstract

Background: Locally advanced bucco-alveolar complex carcinoma (T4b) with supra-notch (supra-sigmoid notch) infratemporal fossa (ITF) extension is an oncological challenge with poor outcome. We analyzed oncological outcome in patients managed with 3-drug neo-adjuvant chemotherapy (NACT) followed with surgical compartmental resection and adjuvant radiotherapy/Chemotherapy-RT (RT/CTRT), i.e., “Triple regimen.” Materials and Methods: Thirty-three cases of T4b bucco-alveolar complex carcinoma with supra-notch ITF extension were included from June 2009 to January 2017. Patients received 3-Drug NACT for 2–3 cycles every 21 days. Response to NACT was assessed with clinical examination, improvement in symptoms (like improved mouth opening etc.,), and Response Evaluation Criteria in Solid Tumors (RECIST) criterion. Patients showing stable disease and responders on NACT underwent compartmental surgical resection with complete ITF clearance followed by adjuvant RT/CTRT. Data were analyzed using STATA 13 and Kaplan − Meir graphs for survival rates. Results: Thirty-one patients (93.9%) showed response on NACT and subsequently went ahead with surgery. Clinical response according to RECIST criterion and subjective clinical improvement of more than 50% was noted in 18 cases while it was <50% in 13 cases. Seventeen of the 31 patients were disease free at last follow-up. There were no recurrences in ITF. The 3-year disease-free survival and disease-specific survival were 69% and 73%, respectively. Conclusion: Three-drug NACT followed by surgical resection in selected cases who show response to NACT with adjuvant chemoradiation provides a realm of hope for these borderline resectable T4b supra-notch cases.