This article is more than 5 years old. Information may no longer be current.
Primary surgery superior to induction selection chemotherapy in advanced oral cavity carcinoma
Click Here to Manage Email Alerts
Patients with advanced oral cavity squamous cell carcinoma who underwent primary surgical treatment demonstrated significantly improved OS, DFS and locoregional control compared with those who underwent induction selection for chemoradiotherapy, according to results of a phase 2 trial.
“To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction,” Douglas Chepeha, MD, MSPH, professor of otolaryngology — head and neck surgery at the University of Michigan Medical School, said in a press release. “But patients with oral cavity cancer can’t tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation. Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes.”
Douglas Chepeha
Researchers at the University of Michigan previously assessed the use of induction selection with chemoradiotherapy for patients who respond well to that treatment, and they determined the approach contributed to effective management of advanced laryngeal cancer.
For the current retrospective, matched-cohort study, researchers extended this treatment approach to patients with advanced oral cavity squamous cell carcinoma to determine whether it conferred benefits with regard to survival or organ preservation.
The study included 19 patients with resectable stage III or stage IV oral cavity squamous cell carcinoma. Those who had a response rate of at least 50% underwent concurrent chemoradiotherapy, whereas patients who had a rate of less than 50% underwent surgical treatment and radiotherapy.
Ten patients demonstrated a response to chemotherapy; of them, three had a complete response and were cancer-free 5 years later. Of the nine patients who underwent surgery after induction selection, two were alive and disease-free after 5 years. Study enrollment was halted early due to poor results.
Researchers compared these patients with a cohort treated with primary surgical extirpation during a similar time period. Median follow-up was 9.4 years in the induction selection cohort and 7.1 years in the surgical cohort. OS, DFS and locoregional control served as the primary outcome measures.
At the 5-year follow-up, patients in the surgical cohort demonstrated significantly higher rates of OS (65% vs. 32%; P=.03), DFS (75% vs. 46%; P=.001) and locoregional control (72% vs. 26%; P<.001).
“Despite success of organ preservation induction selection protocols in the larynx, comparative survival analysis of an induction selection protocol vs. primary surgical extirpation for oral cavity squamous cell carcinoma demonstrates significantly better outcomes in the surgical cohort,” the researchers wrote. “These findings support surgery as the principal treatment for oral cavity squamous cell carcinoma.”
Disclosure: The researchers report no relevant financial disclosures.
Collapse
Click Here to Manage Email Alerts