Phase II trial of induction chemotherapy followed by surgery for squamous cell carcinoma of the oral tongue in young adults

Abstract

Background: We conducted a phase II clinical trial of induction chemotherapy followed by surgery ± radiotherapy for squamous cell carcinoma of the oral tongue (SCCOT) in young adults.

Methods: From September 2001 to October 2004, 23 patients aged 18 to 49 years with clinical T2-3 N0-2 M0 SCCOT and no prior radiotherapy, chemotherapy, or neck dissection underwent induction chemotherapy (paclitaxel, ifosfamide, and carboplatin) followed by glossectomy and neck dissection ± radiotherapy and chemotherapy.

Results: On final surgical pathology, 9 patients (39%) had a complete/major (2 complete) histologic response at the primary tumor site; 8 patients (35%) had no response or progression. Similarly, 9 patients (39%) had a complete response in the neck or remained node negative; 6 patients (26%) had an increase in nodal category. No treatment-associated deaths occurred, and toxicity was modest. At a median follow-up from the end of treatment of 52 months (minimum, 23 months), 10 patients (43%) developed recurrence, and all 10 died of cancer. Crude recurrence/cancer death rates were associated with ≤ a partial response at the tongue (p = .029), poor histologic differentiation (p = .012), and multiple adverse features on final surgical pathology (p = .040).

Conclusion: Response rates and overall survival with this induction chemotherapy regimen were limited, but complete/major response at the tongue was associated with excellent prognosis. Additionally, improved patient selection and predictive tumor biomarkers will be needed for induction chemotherapy to be routinely incorporated into the treatment of oral tongue cancer in young adults.

Figure 1

Disease-free survival (dashed line) and disease-specific survival (solid line) of young adults with SCCOT treated on a phase II trial of induction chemotherapy followed by surgery (September 2001–October 2004).

Figure 2

Disease-free survival (A) and disease-specific survival (B) of young adults with SCCOT treated on a phase II trial of induction chemotherapy followed by surgery, by response at the tongue. Solid line indicates complete/major response at tongue; dashed line indicates ≤ partial response at tongue. (A) Log-rank P = .011. (B) Log-rank P = .011.

Figure 2

Disease-free survival (A) and disease-specific survival (B) of young adults with SCCOT treated on a phase II trial of induction chemotherapy followed by surgery, by response at the tongue. Solid line indicates complete/major response at tongue; dashed line indicates ≤ partial response at tongue. (A) Log-rank P = .011. (B) Log-rank P = .011.