Impact of induction chemotherapy on resectability of borderline resectable/unresectable oral cavity carcinomas

Induction chemotherapy in borderline resectable oral cavity cancers

Abstract

Introduction: To assess the impact of neoadjuvant chemotherapy (NACT) on achieving surgical resectability in patients with borderline resectable or unresectable T4a oral cavity squamous cell carcinoma (OCSCC).

Materials and methods: Patients with borderline resectable or unresectable T4a OCSCC enrolled between October 2023 and June 2025 received three to four cycles of NACT. Post-treatment, patients were assessed for response and resectability using clinical and radiological criteria.

Results: A total of 102 patients received NACT; 65.7% were male (n = 67) and 34.3% were female (n = 35). The median age was 47 years (range: 28–72). All patients received either two-weekly or three-weekly TPF regimens. Tobacco use and combined alcohol–tobacco habits were the most common (44.1% each), followed by tobacco with betel nut (4.9%), betel nut alone (2.9%), and no habits (3.9%). The buccal mucosa was the most frequent primary site (41.1%), followed by the tongue (35.2%). Other sites included the retromolar trigone (8.9%), upper alveolus (6.8%), and gingivobuccal sulcus (6.8%). Most patients presented with cT4aN1 disease (30.3%).The two-weekly TPF regimen was more commonly used (58.8%) than the three-weekly regimen (41.1%). Toxicity was manageable, with 36.3% of patients experiencing no adverse effects. The most frequent response was partial response (39.2%), followed by progressive disease and unevaluable responses (23.5% each), stable disease (8.8%), and complete response (4.9%). Surgery was considered feasible in 33 patients (32.3%), and 25 (24.5%) ultimately underwent surgery. Patients who underwent surgery demonstrated a significantly improved median overall survival (17.4 months) compared with those managed non-surgically (10.2 months; log-rank p = 0.001).

Conclusion: NACT is well tolerated and has an acceptable toxicity profile, enabling conversion to resectability in nearly one-third of patients with borderline resectable or unresectable T4a OCSCC. Surgical intervention significantly improves overall survival, underscoring the potential role of NACT in appropriately selected patients.