Analysis of a treatment strategy for advanced stage oral  squamous cell carcinoma patients. A 100-day multimodal approach

Abstract

Aim The present study aimed to evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by definitive surgery and free fibular transfer in advanced stage oral squamous cell carcinoma patients.

Methods Patients diagnosed with resectable oral squamous cell carcinoma, Stage IVa were enrolled for the study. The patients underwent a planned protocol of neoadjuvant radiotherapy and concurrent chemotherapy, insertions of dental implants in fibula followed by curative and reconstructive surgery. Objective response rate, overall survival, disease free survival and patient quality of life assessments were carried out.

Results A total of eight patients with Stage IVa oral  squamous cell carcinoma were enrolled for the study and treated according to the planned protocol. All patients completed neoadjuvant chemoradiotherapy and surgery; 6 (75%) patients achieved complete response while 2 exhibited partial response (downstaging) on post surgical pathological analysis. After a median follow-up time of 24.6 months and maximal follow up of 34 months, the overall survival was 75% and disease free survival was 87%. Two patients suffered from trismus and are currently undergoing oral physiotherapy. Six patients had orocutaneous fistula which healed. One had extrusion of fibular graft and two patients died.

Conclusion The present study elucidates a treatment strategy for patients with locally advanced squamous cell carcinoma validated for better functional and aesthetic outcome with improved quality of life. Further evaluation is required in a bigger cohort size.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 2018;68: 394-424

The burden of cancers and their variations across the states of India: the global burden of disease study 1990–2016. Lancet Oncol 2018;19(10):1289-1306

Cotic J, Jamsek J, Kuhar M, et al. Implant-prosthetic rehabilitation after radiation treatment in head and neck cancer patients: a case-series report of outcome. Radiol Oncol 2017;51(1):94-100.

Huang SH, O´Sullivan B. Oral cancer: Current role of radiotherapy and chemotherapy. Med Oral Patol Oral Cir Bucal. 2013;18(2):233-240.

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN guidelines): cancer of the oral cavity, version 2; 2018. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.

Kirita T, Yamanaka Y, Imai Y, et al. Preoperative concurrent chemoradiotherapy for stages II–IV oral squamous cell carcinoma: a retrospective analysis and the future possibility of this treatment strategy. Int J Oral and Maxillofac Surg 2012; 41(4):421-428

Klug C, Berzaczy D, Voracek M, Millesi W. Preoperative chemoradiotherapy in the management of oral cancer: a review. Journal of Cranio-Maxillo-Facial Surgery 2008; 36(2): 75-88.

Slotman G. J., Doolittle C. H., Glicksman A. S. Preoperative combined chemotherapy and radiation therapy plus radical surgery in advanced head and neck cancer. Five-year results with impressive complete response rates and high survival. Cancer 2012:69:2736–2743.

Zen Filho E. V., Tolentino E. D. S., Santos P. S. S. Viability of dental implants in head and neck irradiated patients: A systematic review. Head Neck 2016;38:2229-2240.

Tolentino ES, Centurion BS, Ferreira LH et al. Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients. J Appl Oral Sci. 2011;19(5):448–454.

Pompa G, Saccucci M, Di Carlo G et al. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health 2015;15:5

Shugaa-Addin B, Al-Shamiri HM, Al-Maweri S, Tarakji B. The effect of radiotherapy on survival of dental implants in head and neck cancer patients. J Clin Exp Dent. 2016;8(2):194-200.

de Bree R, Wolf GT, de Keizer B, et al. Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond. Head Neck. 2017;39(11):2329–2349.

Chaukar DA, Dcruz AK, Das AK et al. Validation of the University of Washington quality of life questionnaires for head and neck cancer patients in India. Ind J Cancer 2007;44(4):147-154

Haddad R, O’Neill A, Rabinowits G, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 2013;14(3):257–64.

Cohen EE, Karrison TG, Kocherginsky M, et al. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 2014;32:2735-43.

Blanchard P, Baujat B, Holostenco V, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site. Radiother Oncol 2011;100:33–40.

Patil VM, Prabhash K, Noronha V, et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014;50(10):1000–4.

Freier K, Engel M, Lindel K et al. Neoadjuvant concurrent radiochemotherapy followed by surgery in advanced oral squamous cell carcinoma (OSCC): A retrospective analysis of 207 patients. Oral Oncol 2008;44:116– 123

van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, Henegouwen MIVB, Wijnhoven BPL, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.

Park HJ, Jang JK, Park SH, et al. Restaging abdominopelvic computed tomography before surgery after preoperative chemoradiotherapy in patients with locally advanced rectal cancer. JAMA Oncol. 2017;4(2):259–262.

Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): A multicentre, randomised trial. Lancet 2009;373:811-820.

Brizel DM, Esclamado R. Concurrent chemoradiotherapy for locally advanced, nonmetastatic, squamous carcinoma of the head and neck: consensus, controversy, and conundrum. J ClinOncol 2006;24(17):2612-2617.

Gray LH , Conger AD , Ebert M et al. The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol 1953 ;26:638-648.

Wu H, Fanga C, Huanga L, et al. Short-course radiotherapy with immediate or delayed surgery in rectal cancer: A meta-analysis. Int J Surg 2018; 56:195–202.

Rohner D, Bucher P, Hammer B. Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience. Int J Oral Maxillofac Implants 2013;28(5):e221–e229.

Hidalgo DA, Rekow A. A review of 60 consecutive fibula free flap mandible reconstructions. Plast Reconstr Surg 1994;96:585.

Kovács AF. The fate of osseointegrated implants in patients following oral cancer surgery and mandibular reconstruction. Head Neck. 2000;22:111-119.

Schepers RH, Slagter AP, Kaanders JH, et al. Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer. Int J Oral Maxillofac Surg. 2006;35(9):803-8.

Spring L, Greenup R, Niemierko A, et al. Pathologic complete response after neoadjuvant chemotherapy and long-term outcomes among young women with breast cancer. J Natl Compr Canc Netw 2017 Oct;15(10):1216-1223.

Published
2021-01-11
Info
Issue
Section
Articles
Keywords:
Oral cancer, Oral Squamous cell carcinoma, Neoadjuvant chemoradiotherapy, Osseointegration
##article.stats##
  • Abstract views: 80

  • pdf: 53
How to Cite
Deshmukh, S., Jigjinni, V., Zade, B., Jotshi, J., & Patwa, R. (2021). Analysis of a treatment strategy for advanced stage oral  squamous cell carcinoma patients. A 100-day multimodal approach. Journal of Osseointegration, 13(1), 1-6. https://doi.org/10.23805/JO.2020.13.01.1