From the Guidelines
In the treatment of oral cancer, chemotherapy first followed by radiotherapy is not considered the standard treatment, and instead, radiotherapy first or concurrent chemoradiotherapy is preferred for most patients. When considering adjuvant therapy for oral cancer, the primary goal is to minimize morbidity, mortality, and improve quality of life. According to the ESMO clinical recommendations for diagnosis, treatment, and follow-up of squamous cell carcinoma of the head and neck 1, neoadjuvant chemotherapy followed by radiotherapy allows for organ preservation in advanced larynx and hypopharynx cancer, but has no impact on disease-free or overall survival.
Some key points to consider in the treatment plan include:
- A multidisciplinary treatment schedule should be established in all cases
- The patient’s nutritional status must be corrected and maintained
- Dental rehabilitation is indicated before radiotherapy
- Induction chemotherapy with cisplatin/5-fluorouracil/docetaxel followed by radiotherapy alone, or by chemoradiotherapy leads to higher response rates, longer disease-free progression and longer overall survival versus a cisplatin/5-fluorouracil regimen given as induction treatment and followed by the same local therapies 1
In terms of local regional and metastatic recurrence, treatment options include:
- Surgery (if operable) or re-irradiation for selected cases of localized recurrence
- Palliative chemotherapy as the standard option for most patients
- Weekly methotrexate as an accepted treatment, although combination chemotherapy produces higher response rates, no survival benefit has been demonstrated 1
Ultimately, the decision on the sequencing of adjuvant therapy should be individualized based on patient-specific risk factors, performance status, and the multidisciplinary tumor board's assessment, with the primary goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Comparison of Adjuvant Therapies in Oral Cancer
- The choice between radiotherapy first or chemotherapy first in oral cancer treatment depends on various factors, including the stage and location of the cancer, as well as the patient's overall health.
- According to a study published in 2011 2, induction chemotherapy may prolong survival by 8 to 20% and adjuvant concomitant chemoradiotherapy may prolong survival by up to 16%.
- A more recent study from 2021 3 found that chemotherapy in the curative-intent treatment of oral cavity and oropharyngeal cancers only seems to be of benefit when used in specific circumstances together with locoregional treatment.
- The same study 3 found that adjuvant chemoradiotherapy reduces the risk of death by 16%, as compared to radiotherapy alone, and concurrent chemoradiation as compared to radiation alone is associated with a greater than 20% improvement in overall survival.
Efficacy of Chemotherapy Regimens
- A study from 2003 4 found that chemotherapy with cisplatin and 5-fluorouracil combination is effective in patients with advanced squamous cell oral cancer and appears to improve the survival of patients who have a good response.
- Another study from 2017 5 found that neoadjuvant chemoradiotherapy with concurrent cisplatin/5-fluorouracil is associated with increased pathologic complete response and improved survival compared to carboplatin/paclitaxel in patients with locally advanced esophageal cancer.
- A review article from 2020 6 discussed the use of systemic therapy for locoregionally advanced oral cavity cancer, highlighting the importance of considering the role of chemotherapy in curative settings.
Considerations for Treatment
- The treatment of oral cancer often involves a multimodal approach, including surgical resection, radiotherapy, and chemotherapy.
- The choice of adjuvant therapy should be individualized based on the patient's specific needs and circumstances.
- Further research is needed to determine the optimal chemotherapy regimen and timing of administration for patients with oral cancer.