Neoadjuvant Chemotherapy Followed by Surgery in Advanced Oral Squamous Cell Carcinoma-Pathological Response as a Prognostic Indicator?

Objective: To analyze the pathological response and clinical outcomes in patients receiving Neoadjuvant chemotherapy followed by surgery in locally advanced oral squamous cell carcinoma.

Methods: Retrospective study of prospectively collected data of 87 patients who received Neoadjuvant chemotherapy followed by surgery in locally advanced oral squamous cell carcinoma from 2018 to 2021 was done in the department of head and neck surgery. The pathological response to Neoadjuvant chemotherapy was assessed and classified into complete response, partial response and no response. Pathological response and its prognostic importance with various parameters were evaluated.

Results: Total number of 87 patients received Neoadjuvant chemotherapy followed by surgery for locally advanced oral squamous cell carcinoma, 58 cases were of buccoalveolar complex, 27 were of tongue and 2 were of metastasis of unknown origin , complete response to Neoadjuvant chemotherapy was seen in 4 tongue and 2 buccoalveolar complex and 2 metastasis of unknown origin cases, partial response to Neoadjuvant chemotherapy was seen in 35 buccoalveolar complex and 11 tongue cases. Out of total 87 patients 25 patients defaulted adjuvant therapy and did not completed prescribed treatment and were lost to follow up. 62 patients who completed treatment and follow up, 38 (61.2%) patients were present in the complete (6) and partial response (32) group, rest (24) in no response group. In the median follow up period of 42 months, the complete and partial response group patients showed better overall survival (P = 0.058) and disease-free survival (P = 0.174) then the no response group overall survival (P = 0.058) and disease-free survival (P = 0.174) but statistically no significant changes amongst group were observed.

Conclusion: The lesions of the tongue are better responding to buccoavleolar complex lesions in complete response groups. disease-free survival and overall survival are higher in the complete response group compared to no response group.