Return of induction chemotherapy in head and neck squamous cell cancers: is this time different?

The oncological outcome and influence of neoadjuvant chemotherapy on the surgery in the resectable and locally advanced oral squamous cell carcinoma

Aim

The role of neoadjuvant chemotherapy (NCT) in the treatment of advanced oral squamous cell carcinoma (OSCC) is still controversial. Especially, there are still few studies investigating the influence of NCT on the following surgery. In this retrospective single-center attended cohort study, we investigated the oncological effect of NCT and its influence on the following surgery in patients with resectable locally advanced OSCC.

Method

The clinical data of 88 patients with locally advanced but resectable OSCC (T3/4) were reviewed retrospectively. NCT plus conservative surgery and radical surgery were compared. Five-year disease-specific survival (DSS) was observed as the main endpoint.

Results

Among 88 patients enrolled in this study, 56 patients received upfront radical surgery (non-NCT group) and 32 patients received NCT followed by surgery (NCT group). The patients in the non-NCT group had a statistically better DSS than the patients in the NCT group (P=0.041). Twenty-one out of 32 (65.6%) patients who received NCT were good responders including two patients (6.2%) had a complete response and 19 patients (59.4%) had a partial response. There was no statistical difference between good and poor responders in 5-year DSS (P=0.823). Eleven patients (34.4%) had conservative surgery without flap reconstruction and 21 patients had radical surgery with flap reconstruction after NCT. No statistical difference in surgical margins was found between the two types of surgery (P=0.519). There was also no statistical difference in 5-year DSS between the two types of surgery (P=0.652).

Conclusion

NCT plus surgery could not improve survival compared with upfront surgery. NCT could modify the surgical extent but would not affect the surgical margins. This conclusion should be explained cautiously, and randomized clinical trials with large sample size were needed to further answer the question.