Neoadjuvant intra-arterial chemotherapy to avoid reconstructive surgery for oral cancer patients aged ≥80 years

Introduction: This study aimed to evaluate survival in patients aged ≥80 years with oral squamous cell carcinoma (OSCC) treated with intra-arterial chemotherapy using docetaxel, cisplatin, and peplomycin combined with intravenous chemotherapy using 5-fluorouracil (IADCPIVF).Methods: The present study was a retrospective analysis of 32 OSCC patients who were determined to require reconstructive surgery. We performed IADCPIVF as neoadjuvant chemotherapy and then minimally invasive surgeries (MIS) on patients with complete responses or good partial responses.Results: The study population included 16 patients with stage II OSCC, seven with stage III, and nine with stage IV. The primary tumor response rate was 100% (complete response rate, 37.5%; good partial response rate, 28.1%; and fair partial response rate, 34.4%). After IADCPIVF, 32 patients underwent surgery; MIS was performed on 21 patients. The 3-year overall survival rate was 76.5% (stage II, 77.9%; stage III, 85.7%; and stage IV, 55.6%). In the multivariate analysis of survival, clinical tumor response was a significant prognostic factor. The rate of grade 3 adverse events was 46.9%, and most of the events were due to mucositis in the area of the intra-arterial injection.Conclusion: IADCPIVF is highly safe and has an excellent antitumor effect by itself, so it may be a possible new treatment method with high curability, even for patients aged ≥80 years who want to avoid reconstructive surgery and preserve oral function.