3602 - Comparative Analysis of Induction Chemotherapy vs. Upfront Surgery for Locally Advanced Oral Tongue Cancer
Presenter(s)
A. Riaz1, S. M. Raza2, S. Abdullah3, A. Ammar4, W. Hanif5, and M. Arif6; 1CINJ, New Brunswick, NJ, 2Shaukat Khanum Memorial Cancer Hospital, Lahore, Punjab, Pakistan, 3Shaukat Khanum Memorial Cancer and Research Center, Lahore, Punjab, Pakistan, 4Shaukat Khanum Memorial Cancer and Research Center, Lahore, Pakistan, 5Chaudhry Muhammad Akram Teaching and Research Hospital, Lahore, Pakistan, 6Lincoln Medical Center, Bronx, NY
Purpose/Objective(s): To compare clinical to pathologic stage conversion, pathologic response, oncologic outcomes, and toxicity between induction chemotherapy followed by surgery and upfront surgery in patients with locally advanced squamous cell carcinoma (SCC) of the oral tongue.
Materials/Methods: We retrospectively analyzed 199 patients with stage III–IV locally advanced SCC of the oral tongue treated between Jan 2019 and Dec 2024. Patients were divided into induction chemotherapy and upfront surgery groups. All patients underwent surgery followed by risk-adapted (chemo)radiotherapy (60–66 Gy), with concurrent cisplatin administered for high-risk features (positive margins and/or extranodal extension). The induction chemotherapy group additionally received 2–3 cycles of taxane/platinum-based induction chemotherapy. Endpoints included pathologic response, clinical-to-pathologic stage conversion, toxicity, overall survival (OS), and progression-free survival (PFS).
Results: Median age was 53 years (40–65), with 121 males (60.8%). Clinical T stage distribution was cT3 (69.34%), cT4 (15.1%), cT2 (9.6%), cT1 (0.5%), 11 unknown. Clinical nodal stage was cN0 (36.7%), cN1 (33.2%), cN2 (25.1%), cN3 (0.5%), 9 unknown. Tumor grade was grade I in 27.14%, grade II in 58.8%, and grade III in 14.1%. 112 patients (56.3%) received induction chemotherapy, 87 patients (43.7%) underwent upfront surgery. Baseline gender, PS, and risk factors (betel nut, smoking, naswar) were comparable. Patients in the chemotherapy group were younger (mean 49.8 vs 55.2 years, p = 0.002) and with more cT3–T4 disease (96.4% vs 81.4%, p < 0.001). cN stage, grade, and depth of invasion were similar.
In induction chemotherapy group (n=105 with pathology),complete pathologic response was observed in 13 patients (12.4%), partial response in 77 (69.6%), and stable/progressive disease in 15. Four patients with cT4 disease were down staged to ypT2. Downstaging occurred in 60.9% of cT3 and 85.1% of cT4 patients, with no residual ypT4. Nodal response showed that 50% of cN0 patients were node-positive, 41% of cN1 were downstaged to ypN0, 41% upstaged to ypN2–3, and 60% of cN2 were down staged to ypN0–1, indicating meaningful nodal response. Treatment-related toxicities were similar: grade 2 mucositis (33.2% vs 25.6%, p=0.92) and grade =3 dysphagia (32.7% vs 25.6%, p=0.95). Median follow-up was 58 months; median PFS was 44 months vs not reached favoring surgery (NS), and median OS was 43 vs 71 months (p=0.77).Conclusion: Induction chemotherapy achieved significant tumor and nodal downstaging, with a 12.4% complete pathologic response, particularly in cT3–T4 disease, compared to upfront surgery. However, although not statistically significant, OS and DFS were clinically better with upfront surgery. Toxicity outcomes were similar in both groups.