Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results

Locoregionally advanced squamous cell carcinomas of the head and neck conti nue to be a major clinical problem. We demonstrated in 1996 that preoperati ve concurrent cisplatin- or carboplatin-based chemotherapy and radiotherapy plus radical surgery in advanced oral cancer had minimal toxicity, had hig h clinical tumor response rates, was well tolerated and produced impressive complete response rates and a high 5-year survival rate. The purpose of th e present study was the long-term follow-up of this treatment regimen for a dvanced oral carcinoma. Forty-eight patients with squamous cell carcinoma o f the oral cavity (including soft palate) were treated preoperatively with cisplatin- or carboplatin-based chemotherapy in combination with simultaneo us irradiation to a target volume of 40 Gy, and 2-6 weeks later underwent c urative surgery. All patients with advanced Stage II (n = 7), Stage III (n = 22) and Stage IV (n = 19) were treated and followed for an average of 7.2 years (range: 61-144 months). The overall actuarial survival of all patien ts was 81.3% at 5 years and also at 10 years. Progression-free survival at both 5 and 10 years was 84.8% for all patients, and 85.7% for Stage II, 90. 0% for Stage III, and 78.9% for Stage IV patients. Progression-free surviva l rates according to the histopathologic regression grade of primary tumor following preoperative chemoradiotherapy at 10 years were 40.0% for Grade I Ia, 88.9% for Grade IIb, 100% for Grade III, and 87.5% for Grade IV. Patien ts who achieved good responses histopathologically (Grades IIb, III, IV) ha d superior survival rates in comparison to patients with extensive residual tumor (Grade IIa) in surgically resected specimens (p = 0.0012). A better histologic regression grade was also associated with a higher survival rate even in the long-term analysis. This treatment regimen for advanced oral c ancer produced high clinical and pathologic complete response and survival rates with an acceptable acute toxicity profile and lack of late therapeuti c complications. The long-term follow-up showed gratifying results even for advanced oral cancers without a substantial increase in distant metastasis and second primary malignancy. (C) 1999 Elsevier Science Ltd. All rights r eserved.