title: Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers.
abstract: BACKGROUND
  The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012.
  
  
  METHODS
  All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS.
  
  
  RESULTS
  721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p=0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59-25.21 months) and 8.16 months (95%, CI 7.57-8.76) in patients treated with non surgical treatment (p=0.0001).
  
  
  CONCLUSIONS
  In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients.
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
authors.forename: V M
authors.initials: VM
authors.lastname: Patil
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India. Electronic address: kumarprabhashtmh@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Prabhash
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
authors.forename: V
authors.initials: V
authors.lastname: Noronha
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
authors.forename: A
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
authors.forename: V
authors.initials: V
authors.lastname: Muddu
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
authors.forename: S
authors.initials: S
authors.lastname: Dhumal
authors.affiliation: Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Juvekar
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: P
authors.initials: P
authors.lastname: Chaturvedi
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: D
authors.initials: D
authors.lastname: Chaukar
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: P
authors.initials: P
authors.lastname: Pai
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Kane
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: A
authors.initials: A
authors.lastname: Patil
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: J P
authors.initials: JP
authors.lastname: Agarwal
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Ghosh-Lashkar
authors.affiliation: Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
authors.forename: A
authors.initials: A
authors.lastname: Dcruz
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D009062:Mouth Neoplasms / Q000188:drug therapy* / Q000601:surgery; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Head and neck cancer; Induction chemotherapy; Locally advanced; Neoadjuvant chemotherapy; Oral cancers; Technically unresectable