To determine the effectiveness of a cytoreduction strategy for oral cancer using a novel trimodal therapy.
Prospective analysis of 25 patients treated between October 1995 and June 2000 with a protocol named neo-RADPLAT consisting of 4 weekly intra-arterial infusions of cisplatin (150 mg/m2) and intravenous infusions of sodium thiosulfate (9 g/m2), and concurrent radiation therapy (2 daily doses of 50 Gy) followed by tumor nidusectomy (a conventional surgery) at 8 weeks. Five patients had T2 lesions and 20 patients had T3 lesions; the clinical neck cancer stages were N0 in 12 patients, N1 in 9, and N2 in 4 (2 N2a, 1 N2b, and 1 Nc); and there were 17 tumors of the oral cavity (11 of the oral tongue, 5 of the retromolar trigone, and 1 of the floor of mouth) and 8 of the oropharynx (4 of the tonsillar fossa, 3 of the base of tongue, and 1 of the soft palate).
Twenty patients (80%) had a complete response to chemoradiation in the primary site and 11 (79%) had a complete response in the neck. Among the 19 patients who had a tumor nidusectomy after chemoradiation, 5 had residual cancer and required a conventional resection. With regard to major toxicity, there were 6 cases of grade 3 and 1 case of grade 4 hematologic effects, 1 case of grade 3 neurologic effect, 1 case of grade 3 gastrointestinal effect, 1 case of grade 5 cardiac effect, as well as 16 cases of grade 3 mucositis. With a median follow-up of 56 months (range, 28-84 months), the 5-year estimates for overall survival, disease-specific survival, and locoregional control were 54%, 64%, and 74%, respectively. Fourteen patients remain without disease, 6 have died of the disease, and 5 have died of other causes.
Preoperative intra-arterial chemoradiation cytoreduction followed by limited surgery is effective for controlling oral cancer. This tissue-sparing and reduced-radiation strategy may also preserve oral function.