NEW YORK (Reuters Health) Dec 30 - Outcomes of advanced oral cavity squamous cell carcinoma (OCSCC) are better after primary surgery than after so-called "induction selection" chemotherapy, a retrospective study suggests.
Induction selection aims to assign treatment based on the response to one cycle of induction chemotherapy. Responders undergo concomitant chemoradiotherapy, and nonresponders undergo surgery with adjuvant radiotherapy.
Dr. Douglas B. Chepeha from the University of Michigan in Ann Arbor and colleagues reviewed data on 72 patients with advanced OCSCC: 19 treated with an induction selection protocol and 53 who had primary surgery.
Compared with induction selection, primary surgery yielded significantly better overall survival, disease-specific survival, and locoregional control at 1, 3, and 5 years, the authors reported December 26 online in JAMA Otolaryngology Head and Neck Surgery.
Patients who had primary surgery were 2.5 times more likely to survive, 3.6 times more likely to survive free of cancer, and five times more likely to maintain locoregional control.
In the induction selection group, 10 of 19 patients responded to induction chemotherapy, but only three had complete responses after concomitant chemoradiotherapy and remained disease free at five years. Only one of the remaining seven responders underwent successful salvage after failure of definitive chemoradiotherapy and survived to five years.
Only two of the nine nonresponders in the induction selection group were alive with no evidence of disease after surgical extirpation at five years.
"These findings suggest that the induction selection approach for OCSCC does not provide optimum chemoselection of patients and demonstrates that outcomes were significantly worse in the responder and nonresponder induction selection groups when compared with patients treated with primary surgical extirpation and with selective post-operative radiotherapy (PORT)/chemotherapy for high-risk features," the researchers conclude.
"Until better regimens are available," they add, "standard therapy should remain comprehensive surgical resection combined with selective PORT/chemotherapy."
Dr. Chepeha did not respond to a request for comment.
In an email interview with Reuters Health, Dr. Steven J. Want from the University of California, San Francisco, who was not involved in the study, wrote, "The results are consistent with prior reports and the experience of the vast majority of major head and neck cancer treatment centers. That is, primary chemoradiation is inferior to primary surgery for oral cavity carcinoma."
"There may be a small subset of oral cavity carcinoma patients for whom a primary chemoradiation approach is appropriate," Dr. Wang said. "However, the use of induction chemo as selection criteria does not appear to be an effective strategy. Perhaps as we develop more understanding of tumor markers, a molecular marker strategy for selection might prove effective for selecting oral cavity carcinoma patients who may be candidates for primary chemoradiation."
SOURCE: http://bit.ly/JpJKEq
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