Preoperative simultaneous cisplatin- or carboplatin-based chemotherapy and radiotherapy for squamous cell carcinoma of the oral cavity

Background: Encouraging results have been reported with cisplatin- or carboplatin-based chemotherapy regimens and simultaneous irradiation treatment in advanced and unresectable head and neck head and neck cancer. We have therefore examined the effectiveness of such therapy on tumor control, survival, and toxicity in patients with advanced oral squamous cell carcinoma. Methods: Forty-one patients with squamous cell carcinoma of the oral cavity (including soft palate) were treated preoperatively with cisplatin or carboplatin, and 5-fluorouracil or peplomycin in combination with simultaneous irradiation to a target volume of 40Gy, and 2-6 weeks later, curative surgery was performed. Results: Thirty-eight patients (91.7%) had Stage III or IV disease, and three patients had Stage II lesions. The preoperative clinical responses of the primary tumor were: 25 patients (61.0%) achieved a complete response (CR), 15 (36.6%) a partial response (PR), only 1 patient (2.4%) had stable disease or no change (NC). The overall response rate was 97.6%. Histological effects according to the grading system of Shimosato and coworkers [Jpn J Clin Oncol 1:19-35, 1971] were seen in 38/41 (92.7%). Of clinical CR patients, 73.9% were also histologic negative for tumor. Side effects of this therapy were relatively low and reversible. With a median follow-up of 52.8 months (range 17-92 months), 5-year cumulative survival rates were 81.5% for all patients, 100% for Stage II, 88.6% for Stage III, and 76.4% for Stage IV patients, respectively. There was no significant postoperative morbidity. Conclusions: This preoperative chemoradiotherapy regimen was highly active, well tolerated, and appeared to have a survival benefit even for advanced carcinomas of the oral cavity. (C) 1996 Wiley-Liss, Inc.