Role of Neoadjuvant Chemotherapy in Locoregionally Advanced Oral Cancers

Background and Aim: Oral-carcinoma is one of the most common cancer world-wide. Its treatment in advanced conditions to increase the survival rate is a major concern. This study was aimed at assessing the use of neoadjuvant cancer therapy (NACT) for improving the operability in non-operable patients with advanced oral carcinoma (T4b and N3 disease) and to observe easier resection in T4a disease.

Methodology: This prospective study included total 40 patients with advanced oral carcinoma (T4a, T4b, and N3 stages), who were administered with NACT- Cisplatin (80 mg/m2) over 2 days and 5-fluorouracil (750 mg/m2) for 4 days along with hydration and antiemetics (3 cycles for every 4 weeks) and later, if resectable, will be taken for the surgery . Follow up of patients (6 months) was advised to assess recurrence if any. Chi-square test was performed to analyze the association of NACT with resectability and operability in patients. Histopathological examination was done to see for extent and margns status post surgery. Non operable cases were given palliative radiotherapy and symptomatic treatment.

Results: Patients displayed T4a (70%), T4b (30%), and N3 (15%)stages of oral cancer. Stable disease was observed in 57.5% of patients, indicating its importance in cancer treatment. Easier resection was observed in 67.85% i.e. 19 patients. Significant association of locoregionally advanced oral cancer (T4a, T4b and N3 disease) with respectability (P=0.012) and operability (P=0.001) after NACT was observed. The most common adverse events observed during NACT were nausea/vomiting (28.3%), neutropenia (11.66%), diarrhea (8.33%), and anemia (3.33%).

Conclusion: Easier resection in 67.85% cases among operable group seen and 50% of cases among non operable group became operable. Further studies on its profound use in oral squamous cell carcinoma can help reduce morbidity and increase the survival rate.