Neo–adjuvant chemotherapy for locally advanced unresectable oral cancer to improve resectability

Dr. Meena Shah; Dr. Samip M. Pansora; Dr.Rajesh Makadia

Volume : VIII, Issue : VI, June - 2019

Neo–adjuvant chemotherapy for locally advanced unresectable oral cancer to improve resectability

Dr. Meena Shah, Dr. Samip M. Pansora, Dr. Rajesh Makadia

Abstract :

Background: Neo–adjuvant chemotherapy (NACT) in the management of locally advanced unresectable oral cavity cancers (OCC) has generated considerable discussion in recent years. We present a retrospective analysis of patients with locally advanced technically unresectable OCC who received NACT at our centre. Objective: To evaluate impact of NACT in locally advanced unresectable OCC, who are unfit for upfront surgery. Materials and methods: 30 patients with technically unresectable OCC were taken up for study. All the patients were subjected to 3 cycles of NACT (cisplatin+paclitaxel) after doing relevant investigations. Patients with contraindication to cisplatin were given carboplatin. After 3 cycles, patients were reevaluated for resectability and later planned for either surgery with subsequent RT or nonsurgical therapy RT or palliation depending on the response. Results: Of 30 patients, only 27 patients were included in study as 3 patients defaulted. All patients tolerated NACT well. Clinically 5 patients (18.5%) had complete response, 20 (74%) had partial response and 2 patients (7.5%) had progressive disease. overall 25 patients underwent surgery and had R0 resection. At last follow up all patients who underwent surgery were alive and disease free. Conclusions: Several stage IV OCC are treated with nonsurgical modality with poor outcomes. In our analysis, NACT led to successful resection with no unexpected toxicity on subsequent local treatment. NACT has shown the possibility of more limited surgery and greater achievement of resectability (R0 resection).