Neoadjuvant chemotherapy in oral cancers: Selecting the right patients

Abstract

The standard of care treatment for oral squamous cell carcinoma (OSCC) at present, consist of surgical resection followed by adjuvant radiotherapy and chemotherapy as indicated. Despite recent advances the overall prognosis remains guarded. Role of neoadjuvant chemotherapy is being explored with premise of reducing extent of surgical resection, improving loco-regional control and decreasing distant metastasis, thereby improving treatment outcomes by decreasing mortality and morbidity. However, indications of neoadjuvant chemotherapy in oral cancers are not clearly defined. Majority of studies have failed to demonstrate a significant benefit of neoadjuvant chemotherapy in terms of loco regional control and overall survival in resectable OSCC. In a select subset of patients with locally very advanced and unresectable OSCC, neoadjuvant chemotherapy has been shown to cause tumor shrinkage and improve resectability. These hypothesis generating findings of reduction in distant metastasis, improved resectability and functional outcome, however need further validation. In summary, the role of neoadjuvant chemotherapy for OSCC remains investigational and has a limited role outside clinical trial.

Keywords: Neoadjuvant chemotherapy; advanced oral cancers; oral squamous cell carcinoma; unresectable oral cancers.

Figure 1

Postneoadjuvant chemotherapy clinical specimen showing nonconcentric tumor shrinkage in separate areas with intervening tissue

Figure 2

Pre- and post-neoadjuvant chemotherapy positron emission tomography-computed tomography scan showing nonconcentric shrinkage of tumor