Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: A retrospective study from rural India

Abstract

Background:Oral cavity cancer is the most common cancer among rural India. There is a paucity of data for outcomes of operable oral cavity cancer from rural India. Use of maintenance metronomic may delay or avoid relapse.Aim:To evaluate outcomes of operable oral cavity carcinoma and evaluate impact of maintenance metronomic chemotherapy.Objectives:To evaluate disease-free survival (DFS), overall survival (OS), and factors affecting the outcome in operable oral cavity cancer.Materials and Methods:Data of patients diagnosed with oral cavity cancer registered between May 2008 and May 2014 were retrieved. Only those patients with operable oral cavity cancer and upfront definitive surgery were included in the study. Demographic profile, stage, tobacco consumption, adjuvant therapy, and pattern of failure were collected. Kaplan–Meir survival analysis was used to determine DFS and OS. Log-rank test was used to evaluate factors affecting outcome.Results:Median follow-up is 24 months. Out of 335 patients, 225 (67%) had advanced operable cancer with 42/225 (18%) and 183/225 (82%) as Stages III and IVA, respectively. Buccal mucosa was the most common subsite (178/335, 53%) followed by tongue (63/335, 19%). Ninety-two percent patients were addicted to smokeless tobacco, whereas 27% were smokers. Median DFS is 13 months with 2 years relative DFS 32%. Median OS is 30 months, with 2 years OS of 54%. Metronomic adjuvant oral chemotherapy was given in 130/225 (58%); Stage III and IVA patients with median of 14 months (3–18 months). Use of metronomic chemotherapy improved DFS (8 vs. 14 months, P = 0.22) and OS (14 vs. 26 months, P = 0.04).Conclusion:Oral cavity cancer is a major health care problem in rural India. Presentation at advanced stage leads to suboptimal outcomes. Benefit of metronomic maintenance chemotherapy in locally advanced oral cavity needs to be further evaluated prospectively.

Metronomic Chemotherapy: A Systematic Review of the Literature and Clinical Experience

“…The disease-free survival rates were 86,5% in metronomic group versus 71.6% in control group, showing a statistical significance [242]. A similar study from India enrolling operable oral cavity cancer with maintenance metronomic therapy showed a median DFS of 13 months [243]. For head and neck cancer, another study evaluated metronomic oral regimen of methotrexate, erlotinib, and celecoxib in palliative treatment of patients with head and neck cancers and ineligible for MTD.…”

The Overall Efficacy and Outcomes of Metronomic Tegafur-Uracil Chemotherapy on Locally Advanced Head and Neck Squamous Cell Carcinoma: A Real-World Cohort Experience

“…In unresected stage III/IVA/IVB HNSCC, concurrent CRT and lapatinib followed by lapatinib (1500 mg once daily) demonstrated improvement in CRR at six months post-CRT and median PFS in p16-negative disease, but no significant benefit in OS [ 25 ]. In India, maintenance with metronomic oral methotrexate and celecoxib in advanced oral cancer improved both DFS and OS [ 26 , 27 , 28 ]. However, the phase III randomized trial revealed that long-term lapatinib maintenance therapy provided no additional benefits in patients with surgically treated high-risk HNSCC [ 29 ].…”

Smoking Pattern among Rural Indian Cancer Patients: A Prospective Survey

“…In our study, 48% of lung cancers and 39% of head-and-neck cancer patients smoked, predominantly bidi, which is similar to smoking prevalence seen in another major epidemiological Indian study of lung cancer (48%) and higher compared to that seen in oral cavity cancers in rural Indian population (27%), respectively. [17,18] Among several cancer cohorts studied, lung and head-and-neck cancers were the first and second cohorts, respectively, in terms of a higher percentage of patients among them having a history of smoking. As it is a cross-sectional study, the tolerance of smokers to antineoplastic drugs, including radiotherapy and surgery, compared to nonsmokers could not be illustrated.…”