Details
Category: Volume 07 Issue 03 March 2019
Hits: 1120

Title: Feasibility and Efficacy of Neoadjuvant Chemoradiation in Lower Gingivobuccal Complex Cancers Involving Mandible

Authors: Dr P.R.Vijey Karthik, Dr M.Sathiya

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.52

Abstract

Lower gingivobuccal complex cancers is the most common oral cavity cancers which has an increasing trend in India due to tobacco and alcohol intake.

Aim of the Study: Assessment of feasibility and efficacy of Neoadjuvant chemoradiation in locally advanced gingivobuccal complex cancers involving mandible in achieving better clinical response and its impact on survival.

Methods  and Materials

Inclusion Criteria

Biopsy proven locally advanced gingivobuccal complex cancer patients with radiological confirmation of involvement of mandible and are fit for chemotherapy and surgery.

Exclusion Criteria

1) Early stage Head and Neck cancer patients.

2) Patients unfit for  surgery and chemotherapy

Patient with locally advanced lower gingivobuccal complex cancers were taken for analysis after all investigsation done. Patient with disease considered as not resectable due to extensive soft tissue involvement were considered for neoadjuvant chemoradiation followed by which reassessment for surgery done. Patient will be given chemotherapy and radiotherapy for total dose of 50Gy using either conventional or conformal techniques. Patients will be reviewed at 50Gy for assessment for feasibility of surgery. Surgery considered if patient had resectable soft tissue component.

Results: Out of 34 patients considered for Neoadjuvant chemoradiation 7 patients undergone surgery with no evidence of locoregional and distant metastases.

Conclusion: Though we dont have clearcut indications for Neoadjuvant chemoradiotherapy it can be considered in selected subset of patients with extensive soft tissue disease for feasibility of surgery which has impact on locoregional and distant control and functional outcome .Larger studies should be done to assess the credibility of this study.

Keywords: Neoadjuvant chemoradiation, Gingivobuccal complex cancers, locally advanced un resectable cancers, extensive soft tissue component disease.

References

  1. Advanced squamous cell carcinoma of lower gingivobuccal complex: patterns of spread and failure. Pathak KA1, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS, Pai PS, Chaukar DA, D'Cruz AK.Head Neck. 2005 Jul;27(7):597-602.
  2. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients.Pignon JP1, le Maître A, Maillard E, Bourhis J; MACH-NC Collaborative Group. Radiother Oncol. 2009 Jul;92(1):4-14. doi: 10.1016/j.radonc.2009.04.014. Epub 2009 May 14.
  3. Reconstruction of large composite buccal defects using single soft tissue flap--analysis of functional outcome. Kekatpure VD1, Manjula BV, Mathias S, Trivedi NP, Selvam S, Kuriakose MA. 2013 Mar;33(3):184-90. doi: 10.1002/micr.22063. Epub 2012 Dec
  4. Preoperative chemoradiation followed coupled with aggressive resection as needed ensuresnear total control in advanced Head and neck cancer. American Journal of surgery Nov 1997;VOL 5:518 – 522.
  5. Preoperative chemoradiotherapy in management of oral cancer.A review of craniomaxillofacial surgery.March 2008;VOL 2 :75 – 88.
  6. Preoperative chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of oral cavity; An analysis of long term results. Journal of oral oncology Nov 1999, VOL 6 597- 606.
  7. Current management in the management of Head and neck cancer in Medical clinics of North America,Jan 1999 VOL 1 235 – 246.
  8. Multimodal intensification therapy for previously untreated advanced resectable squamous cell carcinoma of oral cavity, oropharynx and hypopharynx. Cancer, Jun 2002 VOL 12 : 3169 – 3178.
  9. Iyer SG ,Pradhan SA, Pai PS. Surgical treatment outcomes of localized squamous cell carcinoma of head and neck. 2004; 26 : 897 – 902.
  10. Klug C, Berzaczy D, Voracek M, Millesi W: Preoperative chemoradiotherapy in the management of oral cancer: A review. J Cranio-Maxillofac Surg 2008, 36:75-88.
  11. Kirita T, Ohgi K, Shimooka H, Yamanaka Y, Tatebayashi S, Yamamoto K, et al.: Preoperative concurrent chemoradio-therapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results. Oral Oncol 1999, 35:597-606
  12. Iguchi H, Kusuki M, Nakamura A, Nishiura H, Kanazawa A, Takayama M, et al.: Concurrent chemoradiotherapy with pirarubicin and 5-fluorouracil for respectable oral and maxillary carcinoma. Acta Otolaryngol Suppl 2004, 554:55-61
  13. Shirasaka T, Shimamoto Y, Ohshimo H, Yamaguchi M, Kato T, Yonekura K, Fukushima M: Development of a novel form of an oral 5-fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5- fluorouracil by two biochemical modulators. Anticancer Drugs 1996, 7:548-557
  14. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958, 53:457-481
  15. Giralt JL, Gonzalez J, del Campo JM, Maldonado J, Sanz X, Pamias J, et al.: Preoperative induction chemotherapy followed by concurrent chemoradiotherapy in advanced carcinoma of the oral cavity and oropharynx. Cancer 2000, 89:939-945.
  16. Adelstein DJ, Saxton JP, Rybicki LA, Esclamado RM, Wood BG, Strome M, et al.: Multiagent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution. J Clin Oncol 2006, 24:1064-1071.
  17. Inuyama Y, Kida A, Tsukuda M, Kohno N, Satake B: S-1 cooperative study group (Head and Neck Cancer Working Group): Late phase II study of S-1 in patients with advanced head and neck cancer. Gan To Kagaku Ryoho 2001, 28:1381-1390
  18. Tsukuda M, Ishitoya J, Mikami Y, Matsuda H, Horiuchi C, Taguchi T, et al.: Analysis of feasibility and toxicity of concurrent chemoradiotherapy with S-1 for locally advanced squamous cell carcinoma of the head and neck in elderly cases and/or cases with comorbidity. Cancer Chemother Pharmacol 2009, 64:945-952.

Corresponding Author

Dr P.R.Vijey Karthik

Department of Radiation Oncology, Madras Medical College, Chennai

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.