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

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.