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P11. Role of chemotherapy in oral cancer – Changing paradigm
Abstracts / Oral Oncology 47 (2011) S74–S156
P9. The impact of neoadjuvant chemotherapy on operable locally advanced squamous cell carcinoma of the buccal mucosa R. Kumar, S.V. Shah, V.L. Choksi * Gujarat Cancer and Research Institute, India Introduction: The aim of this study was to assess the impact of neoadjuvant chemotherapy on non-metastatic locally advanced SCC of the buccal mucosa (T4aN0/N + M0). Methods: We randomly assigned 60 patients with previously untreated, biopsy proven, non-recurrent, non-metastatic SCC of the buccal mucosa with overlying skin involvement to receive neoadjuvant chemotherapy for a maximum of 3 cycles followed by surgery (n = 30) or to undergo upfront surgery (n = 30). Chemotherapy regimens consisting of PF, PMF and TPF were selected according to the patient’s affordability with PF being the most commonly used regimen (66%). Surgery consisted of wide excision with a comprehensive neck dissection (MND or RND) and reconstruction. Patients of both arms received adjuvant radiotherapy for a total of 50–60 Gy. Adjuvant concurrent chemotherapy was given for extracapsular nodal spread and positive margins. Mean follow up period was of 13.5 months. Results: Neoadjuvant chemotherapy was well tolerated without any serious toxicities or mortalities and with an overall response rate of 86.6%. Recurrence rates were higher in the neoadjuvant chemotherapy arm (study arm) (40%) as compared to the upfront surgery arm (control arm) (26.6%). Post operative complications such as wound infection, flap necrosis and orocutaneous fistula in the study arm was 50% compared to 26.6% in the control arm. Wound infection rate was higher in the study arm (23%) compared to the control arm (3.3%). The incidence of positive margins was not studied. Pathologic nodal status was equivalent in both arms (46.6% in study arm and 43.3% in the control arm). Discussion: Our study is limited by the heterogeneity of the chemotherapy regimens and the short follow up. No survival benefit could be determined due to the short follow up. The higher incidence of post-operative complication may have delayed adjuvant treatment leading to higher recurrence rates. We conclude that until larger randomized trials are performed, borderline operable locally advanced buccal mucosa cancer should be treated with upfront surgery followed by radiation or chemo-radiation. doi:10.1016/j.oraloncology.2011.06.252
P10. The role of induction chemotherapy in locally advanced oral cavity cancer W. Jeong*, T. Kwon, M. Sung, K. Kim Department of Otorhinolaryngology–Head & Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea Objectives: This study was conducted to determine the role of induction chemotherapy on survival of locally advanced oral cancer. Methods: A retrospective chart review was performed on the 89 patients with squamous cell carcinoma of oral cavity between 1987 and 2006. These patients received one of three treatments: induction chemotherapy followed by surgery or RT (Group A, n = 38), Surgery with or without postoperative RT (Group B, n = 31), Primary RT alone or with adjuvant therapy (surgery or chemotherapy) (Group C, n = 13), Concomitant chemoradiotherapy (Group D, n = 7). Induction chemotherapy was mainly comprised of two cycles of cisplatin/ 5-fluorouracil (FP). Results: When all 89 patients were analyzed, Group B (5-year survival rate: 65%) showed significantly higher survival rates than
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Group A (5-year survival rate: 34%) and Group C (5-year survival rate: 32%). Especially, although Group B showed significantly higher survival rates than other group in patient with N2, N3 stage, there was no significant difference in overall survival between groups in patients with T3, T4 stage. Conclusions: Although surgery is best treatment option in patients with locally advanced carcinoma of the oral cavity especially with high N stage, induction chemotherapy can be good option to treat advanced oral cavity cancer with large primary tumor in terms of organ preservation when primary tumor size was large (T3, T4 stage). doi:10.1016/j.oraloncology.2011.06.253
P11. Role of chemotherapy in oral cancer – Changing paradigm S. Purohit*, C. Narad, P. Chitlangia, R. Bhise Kidwai Memorial Institute of Oncology, India Squamous cell carcinoma accounts for over 90% of tumor arising in oral cavity. The role of chemotherapy (CT) in oral squamous cell a cancer remains controversial despite many years of intensive investigation. The optimal use of chemotherapy is as yet undefined and the standard treatment modality is either surgery, radiotherapy or combination of both. Chemotherapy traditionally was reserved for the setting of recurrent, usually metastatic disease providing short lived palliation of symptoms but no improvement in survival. The last two decades has seen the evolving role of chemotherapy other than in palliative setting alone. There is now supporting evidence for use of CT in form of combined modality to treat patient with unresectable disease, and as neoadjuvant therapy to downsize the tumor. There are currently several ways in which CT can be incorporated in the management of oral cavity cancer. The article deals with the current and evolving role of CT in oral cancer management. doi:10.1016/j.oraloncology.2011.06.254
P12. Topical 5-aminolevulinic acid mediated photodynamic therapy is an effectively alternative treatment for verrucous carcinoma H.-M. Chen*, H. Yang, B.-S. Lee National Taiwan University Hospital, Taiwan Introduction: Verrucous cancer (VCA) is one of highly prevalent oral cancer. Conventional treatment is widely surgical excision, but the large tissue defect is not preventable. Our previous studies have shown that the topical 5-aminolevulinic acid-mediated photodynamic therapy (topical ALA-PDT) using the 635-nm lightemitting diode (LED) light is very effective for verrucous hyperplasia with no significant tissue defect. In this study, we used the similar strategy to treat VCA. Materials and methods: In this study, 7 VCA locating at varied areas of oral cavity were recruited to be treated with topical ALAPDT using the 635-nm LED once a week. Before topical ALA-PDT treatment, all patients received oral cancer stage work up. Except one VCA was a T4N0M0 case, the others were T2N0M0 cases. Results: All 7 VCA were completely cured with no significant tissue defect. After 1–6 years follow-up, there is no any recurrence or detectable neck lymph nodes metastasis in all 7 VCA. Discussion: VCA is a kind of more outgrowth, but fewer metastasis tumor. These characteristics of VCA compensate the limitations of
P9. The impact of neoadjuvant chemotherapy on operable locally advanced squamous cell carcinoma of the buccal mucosa R. Kumar, S.V. Shah, V.L. Choksi * Gujarat Cancer and Research Institute, India Introduction: The aim of this study was to assess the impact of neoadjuvant chemotherapy on non-metastatic locally advanced SCC of the buccal mucosa (T4aN0/N + M0). Methods: We randomly assigned 60 patients with previously untreated, biopsy proven, non-recurrent, non-metastatic SCC of the buccal mucosa with overlying skin involvement to receive neoadjuvant chemotherapy for a maximum of 3 cycles followed by surgery (n = 30) or to undergo upfront surgery (n = 30). Chemotherapy regimens consisting of PF, PMF and TPF were selected according to the patient’s affordability with PF being the most commonly used regimen (66%). Surgery consisted of wide excision with a comprehensive neck dissection (MND or RND) and reconstruction. Patients of both arms received adjuvant radiotherapy for a total of 50–60 Gy. Adjuvant concurrent chemotherapy was given for extracapsular nodal spread and positive margins. Mean follow up period was of 13.5 months. Results: Neoadjuvant chemotherapy was well tolerated without any serious toxicities or mortalities and with an overall response rate of 86.6%. Recurrence rates were higher in the neoadjuvant chemotherapy arm (study arm) (40%) as compared to the upfront surgery arm (control arm) (26.6%). Post operative complications such as wound infection, flap necrosis and orocutaneous fistula in the study arm was 50% compared to 26.6% in the control arm. Wound infection rate was higher in the study arm (23%) compared to the control arm (3.3%). The incidence of positive margins was not studied. Pathologic nodal status was equivalent in both arms (46.6% in study arm and 43.3% in the control arm). Discussion: Our study is limited by the heterogeneity of the chemotherapy regimens and the short follow up. No survival benefit could be determined due to the short follow up. The higher incidence of post-operative complication may have delayed adjuvant treatment leading to higher recurrence rates. We conclude that until larger randomized trials are performed, borderline operable locally advanced buccal mucosa cancer should be treated with upfront surgery followed by radiation or chemo-radiation. doi:10.1016/j.oraloncology.2011.06.252
P10. The role of induction chemotherapy in locally advanced oral cavity cancer W. Jeong*, T. Kwon, M. Sung, K. Kim Department of Otorhinolaryngology–Head & Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea Objectives: This study was conducted to determine the role of induction chemotherapy on survival of locally advanced oral cancer. Methods: A retrospective chart review was performed on the 89 patients with squamous cell carcinoma of oral cavity between 1987 and 2006. These patients received one of three treatments: induction chemotherapy followed by surgery or RT (Group A, n = 38), Surgery with or without postoperative RT (Group B, n = 31), Primary RT alone or with adjuvant therapy (surgery or chemotherapy) (Group C, n = 13), Concomitant chemoradiotherapy (Group D, n = 7). Induction chemotherapy was mainly comprised of two cycles of cisplatin/ 5-fluorouracil (FP). Results: When all 89 patients were analyzed, Group B (5-year survival rate: 65%) showed significantly higher survival rates than
S77
Group A (5-year survival rate: 34%) and Group C (5-year survival rate: 32%). Especially, although Group B showed significantly higher survival rates than other group in patient with N2, N3 stage, there was no significant difference in overall survival between groups in patients with T3, T4 stage. Conclusions: Although surgery is best treatment option in patients with locally advanced carcinoma of the oral cavity especially with high N stage, induction chemotherapy can be good option to treat advanced oral cavity cancer with large primary tumor in terms of organ preservation when primary tumor size was large (T3, T4 stage). doi:10.1016/j.oraloncology.2011.06.253
P11. Role of chemotherapy in oral cancer – Changing paradigm S. Purohit*, C. Narad, P. Chitlangia, R. Bhise Kidwai Memorial Institute of Oncology, India Squamous cell carcinoma accounts for over 90% of tumor arising in oral cavity. The role of chemotherapy (CT) in oral squamous cell a cancer remains controversial despite many years of intensive investigation. The optimal use of chemotherapy is as yet undefined and the standard treatment modality is either surgery, radiotherapy or combination of both. Chemotherapy traditionally was reserved for the setting of recurrent, usually metastatic disease providing short lived palliation of symptoms but no improvement in survival. The last two decades has seen the evolving role of chemotherapy other than in palliative setting alone. There is now supporting evidence for use of CT in form of combined modality to treat patient with unresectable disease, and as neoadjuvant therapy to downsize the tumor. There are currently several ways in which CT can be incorporated in the management of oral cavity cancer. The article deals with the current and evolving role of CT in oral cancer management. doi:10.1016/j.oraloncology.2011.06.254
P12. Topical 5-aminolevulinic acid mediated photodynamic therapy is an effectively alternative treatment for verrucous carcinoma H.-M. Chen*, H. Yang, B.-S. Lee National Taiwan University Hospital, Taiwan Introduction: Verrucous cancer (VCA) is one of highly prevalent oral cancer. Conventional treatment is widely surgical excision, but the large tissue defect is not preventable. Our previous studies have shown that the topical 5-aminolevulinic acid-mediated photodynamic therapy (topical ALA-PDT) using the 635-nm lightemitting diode (LED) light is very effective for verrucous hyperplasia with no significant tissue defect. In this study, we used the similar strategy to treat VCA. Materials and methods: In this study, 7 VCA locating at varied areas of oral cavity were recruited to be treated with topical ALAPDT using the 635-nm LED once a week. Before topical ALA-PDT treatment, all patients received oral cancer stage work up. Except one VCA was a T4N0M0 case, the others were T2N0M0 cases. Results: All 7 VCA were completely cured with no significant tissue defect. After 1–6 years follow-up, there is no any recurrence or detectable neck lymph nodes metastasis in all 7 VCA. Discussion: VCA is a kind of more outgrowth, but fewer metastasis tumor. These characteristics of VCA compensate the limitations of