Neoadjuvant Chemotherapy for Locally Advanced Squamous Carcinoma of Oral Cavity: a Pilot Study.
AbstractTo evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF) induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SPSS version 17 was used for data analysis. Median follow-up was 16 months. The median age of the patients was 62 years old (23-75 years). Man/woman ratio was 1.13. The primary site of the tumor was the tongue in most patients (48%). No significant difference was observed between pathologic characteristics of the two groups. Chemotherapy group showed 16% complete pathologic response to TPF. No significant difference in organ preservation surgery or overall survival was detected. However, the patients in the chemotherapy group had longer progression-free-survival (P=0.014). Surgery followed by chemoradiotherapy with or without TPF induction results in similar survival time. However, progression-free-survival improves with the TPF induction chemotherapy. Studies with more patents and new strategies are recommended to evaluate organ preservation improvement and long-term outcomes.
Siegel R, Naishadham D, Jemal A. Cancer Statistics, 2013. Cancer J Clin 2013;63(1):11-30.
Oliver RJ, Clakson JE, Conway DI, et al. Interventions for= the treatment of oral and oropharyngealcancers:surgicaltreatment. Cochrane Database System Rev 2007;(4):CD006205.
Cmelac A, Arneson K, Chau NG, et al. Locally advanced head and neck cancer. Am Soc Oncol Educ Book 2013:237-44.
Furness S, Glenny AM, Worthington HV, et al. Interventions for the treatment of oral cavity and oropharyngealcancer: chemotherapy. Cochrane Database Syst Rev 2011;13(4): CD006386.
Ma J, Liu Y, Zhang ZY, et al. Induction chemotherapy decreases the rate of distant metastasis in patients with head and neck squamous carcinoma:a metanalysis. Oral Oncol 2012;48(11):1076-84.
Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11:a comparison of non-surgical treatment strategies to preserve larynx with locally advanced larynx cancer. J Clin Oncol 2013;31(7):845-52.
Forastiere A, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Eng J Med 2003;349(22):2091-98.
Vokes EE. Competing roads to larynx preservation. J Clin Oncol 2013;31(7):833-5.
Pignon JP, Bourhis J, Domenge C, et al. Chemotherapyadded to locoregional treatment for head and neck SCC: three meta-analysis of updated individual data. MACH-NC collaborative group. Lancet 2000;355(9208):949-55.
Ma J, Liu Y, Yang Xi, et al. Induction chemotherapy in patients with resectable head and neck SCC:a metaanalysis. World J Surg Oncol 2013;11(1):67.
Karagoglu KH, Buter J, Leemans CR, et al. Subset ofpatients with verrucouscarcinoma of oral cavity who benefit from treatment with methotrexate. Br J Oral Maxillofacial Surg 2012;50(6):513-8.
Licitra L, Grandi C, Guzzo M. Primary chemotherapy in resectable oral cavity SCC. J Clin Oncol 2003;21(2):327-33.
Myers LL, Sumer BD, Truelson JM, et al. Impact of treatment sequence of multimodal therapy for advanced oral cavity cancer with mandible invasion. Otolaryngol Head Neck Surg 2011;145(6):961-6.
Jimi E, Shin M, FurutaH, et al. The RANKL/RANK system as a therapeutic target for bone invasion by oral SCC (Review). Int J Oncol 2013;42(3):803-9.
Lefebvre JL, Pointreau Y, Rolland F, et al. Induction Chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: TREMPLIN randomized phase II study. J Clin Oncol 2013;31(7):853-9.
Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and Fluorouracil Alone or with Docetaxel in Head and Neck Cancer. N Engl J Med 2007;357(17):1705-15
Remenar E, Van Harpen C, Germa L, et al. A randomized phase II multicenter trial of neoadjuvantdocetaxel plus cisplatin and 5-FU vs. PF in patients with locally advanced unresectable SCC of the head and neck. Am Soc Clin Oncol 2006;241:85;
Forastiere AA1, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31(7):845-52.
Billan S, Kaidar-Person O, AtrashF, et al. Toxicity of induction chemotherapy with docetaxel, cisplatin, and 5- FU foe advanced head and neck cancer. Isr Med Assoc J 2013;15(5):231-5.
Crombie AK, Farah CS, Batstone MD. Health-related quality of life of patients treated with primary chemoradiation for oral cavity SCC: a comparison with surgery. Br J Oral Maxillofac Surg 2014;52(2):111-7.
Himmel M, Hartmann M, Guntinas-Lichius O. Cost effectiveness of neoadjuvant chemotherapy in locally advanced operable head and neck cancer followed by surgery and postoperative radiotherapy: a markov modelbased decision analysis. Oncology 2013;84(6):336-41.
Oretal K, Spiegel K, Schmalenberg H, et al. Phase I trial of split-dose induction docetaxel, cisplatin, and 5-fluorouracil (TPF) chemotherapy followed by curative surgery combined with postoperative radiotherapy in patients with locally advanced oral and oropharyngeal squamous cell cancer (TISOC-1). BMC Cancer 2012;12:483-92.
Brockstein B, Haraf DJ, Rademaker AW, et al. Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multiinstitutional experience. Ann Oncol 2004;15(8):1179-86.
Haddad R, O’Neill A, Rabinowits G, et al. Induction chemotherapy followed by concurrent chemoradiotherapy(sequential therapy) vs. concurrent chemoradiotherapy alone in locally advanced head and neck cancer(PARADIGM):a randomized phase 3trial. Lancet Oncol 2013;14(3):257-64.
Posner MR, Norris CM, Wirth LJ, et al. Sequential therapy for the locally advanced larynx and hypopharynx cancer subgroups in TAX324: survival, surgery, and organ preservation. Ann Oncol 2009;20(5):921-7.
Psyrri A, Seiwert TY, Jimeno A. Molecular pathways in head and neck cancer: EGFR, PI3K, and more. Am Soc Clin Oncol Educational Book 2013:246-55.
Stransky N, Egloff AM, Tward AD, et al. The mutational landscape of Head and Neck squamous cell carcinoma. Science 2011;333(6046):1157-60.
Psyrri A, Licitra L, De Blas B, et al. Safety and efficacy of cisplatin plus 5-FU and cetuximab in HPV-positive and HPV-negative recurrent and/or metastatic SCC of head and neck: analysis of the phase III EXTREME trial. Ann Oncol 2012;23(Suppl 9):ix334-47.
Holsinger FC, Piha-Paul SA, Janku F, et al. Biomarker- Directed Therapy of Squamous Carcinomas of the Head and Neck: Targeting PI3K/PTEN/mTOR Pathway. J Clin Oncol 2013;31(9):e137-40.