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Published on: February 12, 2017
Neoadjuvant docetaxel, cisplatin, and capecitabine in borderline-inoperable locally advanced oral cavity squamous
Abhimanyu Singh1, Manu Malhotra1, Amit Sehrawat2
1Dept of Otorhinolaryngology - Head & Neck surgery, AIIMS Rishikesh, Uttarakhand, India.
Introduction:
Borderline-inoperable locally advanced oral cavity squamous cell carcinoma (LAOSCC) represents a therapeutic grey zone in which upfront surgery is technically feasible but oncologically uncertain. In such cases, neoadjuvant chemotherapy (NACT) is employed to enable reassessment of operability rather than to confer a survival advantage. Evidence regarding optimal induction regimens in this setting remains limited.
Materials And Methods:
This prospective observational study included treatment-naïve patients with borderline-inoperable stage III-IV oral cavity squamous cell carcinoma. Patients received neoadjuvant chemotherapy with Docetaxel, Cisplatin, and Capecitabine (TPX). Tumour response was assessed using RECIST version 1.1, and treatment-related toxicity was graded according to CTCAE version 5.0. Following NACT, operability was reassessed by a multidisciplinary team. Surgical and immediate postoperative outcomes were documented for patients undergoing resection.
Results:
Forty-five patients were enrolled, the majority presenting with advanced T-stage disease. An objective response rate of 53.3% was observed following NACT. Conversion to operability was achieved in 13 patients (28.9%), all of whom proceeded to definitive surgery. Margin-negative (R0) resection was achieved in all operated cases. Severe (grade 3-4) treatment-related toxicities occurred in a minority of patients, and chemotherapy discontinuation due to toxicity was infrequent.
Conclusion:
Neoadjuvant chemotherapy with Docetaxel, Cisplatin, and Capecitabine is a feasible and well-tolerated induction strategy in selected patients with borderline-inoperable LAOSCC. TPX was associated with meaningful tumour response and conversion to operability, enabling margin-negative surgical resection without unacceptable toxicity. These findings suggest that TPX as a pragmatic neoadjuvant option in carefully selected patients.
