Neoadjuvant chemotherapy for locally advanced oral mucosal cancer

Introduction. Oral mucosal cancer is one of the most complex tumors of the head and neck. most patients seek help with a locally advanced process where the tumor affects surrounding organs and tissues. Surgical treatment in such cases is accompanied by significant functional and aesthetic disorders, and 5-year disease-free survival does not exceed 50 %. In this regard, additional treatments for oral mucosal cancer, such as neoadjuvant chemotherapy, which can improve survival rates, are being actively investigated.

Aim. To evaluate the efficacy of neoadjuvant chemotherapy and its impact on survival in patients with locally advanced oral mucosal cancer.

Materials and methods. The study included 188 patients with resectable locally advanced stage III–Iv oral mucosal cancer (T2 – T4N0–2c) who were treated at the N. N. Blokhin National Oncology Research medical Center from 2013 to 2023. patients were divided into 2 groups. group 1 (n = 38) included patients who underwent neoadjuvant chemotherapy followed by surgery, group 2 (n = 150) included patients who underwent surgical treatment with adjuvant radiation / chemoradiation therapy. In 55.3 % of cases, the DCf regimen (docetaxel, cisplatin, 5-fluorouracil) was used, in 18.4 % – Cp (carboplatin, paclitaxel), in 26.3 % – pf (cisplatin, 5-fluorouracil). Clinical and morphological responses were assessed by solid tumor response criteria (Response evaluation criteria in solid tumors, RECIST 1.1). Statistical analysis was performed using IBm SpSS Statistics 27 software.

Results. In 44.7 % of patients with locally advanced oral mucosal cancer, neoadjuvant chemotherapy provides a clinical response to treatment, in 25 % of patients – with a pronounced morphological tumor response (grade III–Iv). It was found that in the neoadjuvant chemotherapy group, the incidence of disease progression is significantly lower than in the surgical treatment group (34.2 % versus 53.3 %), overall survival rates are better (48.7 % versus 40.4 %). In patients with a pronounced morphological response after neoadjuvant chemotherapy, the recurrence rate was lower than in patients with a worse response: in 12.5 and 29.2 % of cases, respectively. Nevertheless, there were no significant differences in survival rates between the neoadjuvant and surgical treatment groups (p = 0.063).

Conclusion. Neoadjuvant chemotherapy contributes to improved treatment outcomes for locally advanced oral mucosal cancer. An increase in the number of patients with a pronounced morphological response can lead to a statistically significant increase in survival rates.