Impact of induction chemotherapy on resectability of borderline resectable/unresectable oral cavity carcinomas

Introduction: To assess the impact of neoadjuvant chemotherapy (NACT) on achieving surgical resectability in patients with borderline resectable or unresectable T۴a oral cavity squamous cell carcinoma (OCSCC).Materials and methods: Patients with borderline resectable or unresectable T۴a OCSCC enrolled between October ۲۰۲۳ and June ۲۰۲۵ received three to four cycles of NACT. Post-treatment, patients were assessed for response and resectability using clinical and radiological criteria.Results: A total of ۱۰۲ patients received NACT; ۶۵.۷% were male (n = ۶۷) and ۳۴.۳% were female (n = ۳۵). The median age was ۴۷ years (range: ۲۸–۷۲). All patients received either two-weekly or three-weekly TPF regimens. Tobacco use and combined alcohol–tobacco habits were the most common (۴۴.۱% each), followed by tobacco with betel nut (۴.۹%), betel nut alone (۲.۹%), and no habits (۳.۹%). The buccal mucosa was the most frequent primary site (۴۱.۱%), followed by the tongue (۳۵.۲%). Other sites included the retromolar trigone (۸.۹%), upper alveolus (۶.۸%), and gingivobuccal sulcus (۶.۸%). Most patients presented with cT۴aN۱ disease (۳۰.۳%).The two-weekly TPF regimen was more commonly used (۵۸.۸%) than the three-weekly regimen (۴۱.۱%). Toxicity was manageable, with ۳۶.۳% of patients experiencing no adverse effects. The most frequent response was partial response (۳۹.۲%), followed by progressive disease and unevaluable responses (۲۳.۵% each), stable disease (۸.۸%), and complete response (۴.۹%). Surgery was considered feasible in ۳۳ patients (۳۲.۳%), and ۲۵ (۲۴.۵%) ultimately underwent surgery. Patients who underwent surgery demonstrated a significantly improved median overall survival (۱۷.۴ months) compared with those managed non-surgically (۱۰.۲ months; log-rank p = ۰.۰۰۱).Conclusion: NACT is well tolerated and has an acceptable toxicity profile, enabling conversion to resectability in nearly one-third of patients with borderline resectable or unresectable T۴a OCSCC. Surgical intervention significantly improves overall survival, underscoring the potential role of NACT in appropriately selected patients.Introduction: To assess the impact of neoadjuvant chemotherapy (NACT) on achieving surgical resectability in patients with borderline resectable or unresectable T۴a oral cavity squamous cell carcinoma (OCSCC). Materials and methods: Patients with borderline resectable or unresectable T۴a OCSCC enrolled between October ۲۰۲۳ and June ۲۰۲۵ received three to four cycles of NACT. Post-treatment, patients were assessed for response and resectability using clinical and radiological criteria. Results: A total of ۱۰۲ patients received NACT; ۶۵.۷% were male (n = ۶۷) and ۳۴.۳% were female (n = ۳۵). The median age was ۴۷ years (range: ۲۸–۷۲). All patients received either two-weekly or three-weekly TPF regimens. Tobacco use and combined alcohol–tobacco habits were the most common (۴۴.۱% each), followed by tobacco with betel nut (۴.۹%), betel nut alone (۲.۹%), and no habits (۳.۹%). The buccal mucosa was the most frequent primary site (۴۱.۱%), followed by the tongue (۳۵.۲%). Other sites included the retromolar trigone (۸.۹%), upper alveolus (۶.۸%), and gingivobuccal sulcus (۶.۸%). Most patients presented with cT۴aN۱ disease (۳۰.۳%).The two-weekly TPF regimen was more commonly used (۵۸.۸%) than the three-weekly regimen (۴۱.۱%). Toxicity was manageable, with ۳۶.۳% of patients experiencing no adverse effects. The most frequent response was partial response (۳۹.۲%), followed by progressive disease and unevaluable responses (۲۳.۵% each), stable disease (۸.۸%), and complete response (۴.۹%). Surgery was considered feasible in ۳۳ patients (۳۲.۳%), and ۲۵ (۲۴.۵%) ultimately underwent surgery. Patients who underwent surgery demonstrated a significantly improved median overall survival (۱۷.۴ months) compared with those managed non-surgically (۱۰.۲ months; log-rank p = ۰.۰۰۱). Conclusion: NACT is well tolerated and has an acceptable toxicity profile, enabling conversion to resectability in nearly one-third of patients with borderline resectable or unresectable T۴a OCSCC. Surgical intervention significantly improves overall survival, underscoring the potential role of NACT in appropriately selected patients.

کلیدواژه ها:

Neoadjuvant chemotherapy ، Borderline resectable ، Unresectable ، Oral cavity cancer ، Overall survival