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

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KM Cheung, RKC Ngan, JCH Chow, TY Lee, KWS Li, HC Cheng, CWL Leung, HHY Yiu, S Yau, JSK Au, KH Wong

Hong Kong J Radiol 2018;21:124-31

DOI: 10.12809/hkjr1816962

Introduction: To report the outcome for patients with stage IVA oral cavity (OC) cancer treated by docetaxel-cisplatin–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.


Author affiliation(s):
KM Cheung, RKC Ngan, JCH Chow, TY Lee, KWS Li, HC Cheng, CWL Leung, HHY Yiu, S Yau, JSK Au, KH Wong: Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong







結果:在使用誘導化療的11名患者中,其中4名(36.4%)因病情較嚴重不能即時切除,另外7名(63.6%)希望透過誘導化療在等候手術期間減慢病情。接受誘導化療的患者的年齡介乎32至65歲,中位數為55歲。每位患者約接受3至4週期的化療。誘導化療一般能為患者接受,出現3至4級中性白血球過低或嚴重貧血的機會率各為9.1%。接受誘導化療後,10名(90.9%)患者的腫瘤能被手術完全切除。手術樣本病理化驗顯示,1名(9.1%)患者的腫瘤被完全緩解、5名(45.4%)有改善、3名(27.3%)病情穩定以及2名(18.2%)病情惡化。患者中位隨訪時間為49.5個月。誘導化療也改善生存率(風險比例為0.24;p = 0.022)和無遠處轉移生存率(風險比例為0.24;p = 0.024)。兩組的局部區域控制率相若(66%比53%;p = 0.191)。