Neoadjuvant chemo best option for unresectable oral cavity cancer
Dr Sudhir V Nair - Tata Memorial Centre, Mumbai, India
Actually it is an overview of the role of neoadjuvant chemotherapy in oral cancers, locally advanced oral cancers, because the standard of care for locally advanced oral cancer patients is surgery followed by adjuvant treatment. We are looking whether there is a role for chemotherapy before definitive treatment. We had a meta-analysis some time back, published in 2009, which showed a benefit of chemotherapy, adding chemotherapy in the treatment regimen and showed an overall survival benefit of 5%. Neoadjuvant chemotherapy is being considered in locally advanced cases where up front surgery may be difficult or it’s deemed as inoperable or unresectable.
How many cases are you looking at?
In our hospital 70% of patients coming are almost having advanced cancers and 40-50% of total patients may be unresectable cases. So actually either we have to send them for palliative treatment or we should consider chemotherapy and see whether they can be taken up for surgery in a later period of time if they respond very well to the chemotherapy.
How many people were involved in the study?
We have presented the data of 720 patients, approximately. It’s a retrospective study, we have done induction chemotherapy in the Tata Memorial Hospital for locally advanced patients.
What type of chemo are these patients getting?
They were given the standard chemotherapy which is being used. It consists of a taxane, which is paclitaxel or docetaxel, cisplatin is common and sometimes we use 5-fluorouracil. So either a two drug or three drug regimen we use.
What did you find?
We found about 45% of patients became fit for surgery after subjecting them to chemo and then they were operated and given the standard of care. So we compared the data which patients who have been fit for surgery with those who were unfit for surgery even after chemotherapy. The surgery patients who received the standard of care means they underwent surgery and adjuvant treatment, they fared better compared to those patients who received chemo and just plain radiotherapy or chemoradiotherapy after the treatment. So surgery has a great role but some patients we give chemo, it enhances the chance of them getting operated.
What’s the take-home message?
The standard of care is still the best option, which is surgery followed by chemo or chemoradiotherapy or radiotherapy, it depends upon the risk factors associated with tumours. In case patients who are not fit for surgical resection up front we should consider giving them neoadjuvant chemotherapy. At least 40-50% of these patients we may be able to operate at a future date so that will offer them a better survival.
