Can Neoadjuvant Chemotherapy before Definitive Surgery Improve Outcome in Operable Stage IVA Oral Cavity Cancers?

Abstract

Introduction: To report the outcome for patients with stage IVA oral cavity (OC) cancer treated by docetaxelcisplatin-5-fluorouracil (TPF) neoadjuvant chemotherapy (NC) and surgery. Methods: This retrospective cohort study involved 69 consecutive patients with squamous cell carcinoma (SCC) of the OC managed from April 2012 to April 2015. Eleven stage IVA patients were treated by TPF NC before surgery following tumour board assessment. Another 11 stage IVA patients from the same cohort who received upfront surgery and adjuvant treatment were identified as controls. Results: TPF NC was given to four (36.4%) patients with a marginally resectable tumour and seven (63.6%) to prevent rapid clinical progression while awaiting definitive surgery. The median age at treatment was 55 (range, 32-65) years. A median of three (range, 3-4) cycles of NC were given. NC was well tolerated; grade 3 or 4 neutropenia or anaemia were observed in one (9.1%) patient each. Clinical complete response (CR), partial response, stable disease and progressive disease were observed in one (9.1%), five (45.4%), three (27.3%) and two (18.2%) patients, respectively. Complete (R0) resection was achieved in 10 (90.9%) patients. One (9.1%) patient had pathological CR. Median follow-up period was 49.5 months. Overall survival was significantly improved with NC (hazard ratio 0.24, median survival not reached [NR] vs. 12 months, p = 0.022). Distant relapse-free survival was also significantly improved with NC (hazard ratio 0.24, NR vs. 9.5 months, p = 0.024). Locoregional control rates were not significantly different (66% with NC vs. 53% without NC, p = 0.191). Conclusion: The outcomes of our small cohort suggested that TPF NC given before surgery could improve overall and distant relapse-free survival in patients with stage IVA OC SCC.