Five-Year Follow-Up of Concomitant Accelerated Hypofractionated Radiation in Advanced Squamous Cell Carcinoma of the Buccal Mucosa: A Retrospective Cohort Study

Abstract

In resource limited settings, induction chemotherapy with Gemcitabine and Cisplatinum and concurrent hypofractionated chemoradiation for locally advanced carcinoma of buccal mucosa (BMSCC) are a cost effective option but remain under reported. The objective of this study was to report long term survival outcome after concurrent hypofractionated radiotherapy in locally advanced BMSCC. Between February 2005 and 2009, 63 patients received treatment. Induction chemotherapy (IC) regimen consisted of two drugs: Gemcitabine and Cisplatin. All patients received 55 Gy of radiation in 20 fractions with concurrent single agent Cisplatin (75 mg/m2). Five-year overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were determined. Based on AJCC staging, 7 (11%) patients were stage III, 31 (49%) stage IV a, and 25 (40%) stage IVb at presentation. After IC, 8 (18%) patients had complete radiological response, 33 (73%) had partial response, and 4 (9%) had stable disease. After concurrent hypofractionated chemoradiation, thirty-nine (62%) patients were complete responders and 24 (38%) had stable disease. With a minimum follow-up of 60 months, 5-year OS, DFS, and PFS were 30%, 49%, and 30%, respectively. In locally advanced buccal mucosa squamous cell carcinoma, concurrent hypofractionated chemoradiation results in acceptable survival and regimen related toxicity.

Clinico-pathological prognosticators in oral squamous cell carcinoma

“…[5][6][7][8] Various published studies have demonstrated the significance of anatomic location in the survival of OSCC, as depicted in Table 1. [9][10][11][12][13][14][15][16][17][18][19] Cases which occurred on the buccal mucosa tend to be well differentiated, whereas cancers of palate, tongue and floor of the mouth are poorly differentiated. 20 In a case study (2311 patients, below 45 years of age) by Santos et al, an association between the primary location of tumour and advanced clinical stage showed that increased cases of advanced stages were found in the intraoral sites as compared to the lips.…”

“…Overall 5-year survival rates based on the location of OSCC. [9][10][11][12][13][14][15][16][17][18][19] Location Table 2. Five-year survival rates of OSCC patients based on TNM staging.…”

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

“… 19 , 24 , 26 , 28 , 32 , 33 , 35 , 40–42 , 50 The number of participants for each intervention group varied from 16 27 to 256 42 people. Twelve studies 19 , 21 , 24–26 , 28 , 32 , 33 , 35 , 40 , 42 , 50 only focused on patients with clinical stage III/IV oral cancer, whereas two studies 27 , 41 also included other clinical stages. The main outcomes assessed were OS and LRC, which were evaluated in 10 24–28 , 32 , 33 , 35 , 40 , 41 , 50 and seven 24–26 , 33 , 35 , 40 , 41 studies, respectively ( Table 1 ).…”

“…Regarding those studies that used 2–3 drug regimen CT, cisplatin was combined with docetaxel, 26 , 40 carboplatin, 41 gemcitabine, 28 5-fluorouracil (5-FU), 41 and paclitaxel. 41 Hayashi 26 evaluated the use of intra-arterial CT (total, 150 mg/m 2 cisplatin and 60 mg/m 2 docetaxel) with daily conventional RT (total, 60 Gy/30 fr) for 6 weeks.…”

“…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.…”