By Dr. Khurram Shehzad
Abstract:
Objective
The optimal management of inoperable oral cavity squamous
cell carcinoma (OC- SCC) remains largely unknown.
Especially where surgical management is not a feasible option.
It is reasonable to consider definitive concurrent
chemoradiotherapy (CCRT) in such cases as non surgical
curative option.
The aim of this study was to review 15-year experience at our
institution in treating unresectable oral cavity cancer patients
with definitive CCRT with or without induction chemotherapy.
Methods
This was retrospective cohort study, the Head and Neck cancer
database at our institution was used to identify patients with
primary OC-SCC locally advanced, treated with definitive
CCRT between January 2009 and December 2023. The local
control (LC), regional control (RC), distant control (DC) and
overall survival (OS) were calculated by the Kaplan-Meier
method. Multivariable analysis using Cox proportional hazards
regression used to identify predictors of survival outcomes. All
reported p-value < 0.05 considered statistically significant.
Results
31 patients with locally-advanced OC-SCC were treated with
definitive CCRT. Non-operative management was due to
surgical unresectability 61.3%, Surgery refused 32.3% and
medical inoperability 6.5%. The majority of the patients were
in advanced stage 67.7% and N2c stage 48.4%. The
predominant stage was IVA 77.4%. The commonest primary
site was oral tongue 64.5%. Induction chemotherapy was
administered to 77.4% of them, primarily with Docetaxel,
Cisplatin and 5-FU regimen (TPF) 50%. Post-induction
chemotherapy response evaluation revealed a partial response
in 81% while progressive disease in 19%. Cisplatin was used as
concurrent agent in 60.7% and the radiotherapy was delivered
at mean total radiation dose of 67Gy (60-70 Gy).The median follow up was 25 months (9-90 months), while the median
survival time was approximately 25.6 months. The 2-year
(LC), (RC), (DC) and (OS) were 19%, 50%, 66%, and 50%
respectively. Performance status, T4b staging, IVB stage, local
and regional failure significantly impacted survival outcomes
(p < 0.01). Feeding tube placement was required in 38.7% of
patients, and only 9.7% underwent salvage surgery.
Conclusion
This study highlights poor survival outcomes and high failure
rates in patients with unresectable OC-SCC treated with
definitive CCRT, emphasizing the aggressive nature of the
disease and the challenges in achieving durable local control
with non-surgical approaches.