Concurrent cisplatin-based chemotherapy versus radiotherapy alone as adjuvant therapy for squamous cell carcinoma of the oral cavity bearing high-risk features

Background: To compare concurrent cisplatin-based chemoradiation in an adjuvant setting for high-risk squamous cell carcinoma of oral cavity terms of toxicity, local-regional control, and overall survival. Materials and Methods: A total of 54 patients of postoperative squamous cell carcinoma of oral cavity with high-risk features were randomized into two groups; postoperative radiation (60 Gy/30#/6 weeks) or postoperative concurrent chemoradiation (60 Gy/30#/6 weeks with weekly concurrent cisplatin 50 mg) arms. Results: Buccal mucosa was the most common sub site (44.4%) affected, followed by lower alveolus/alveolar ridge (37%) and most tumors (64.3%) were well-differentiated. About 67.3% of the patients completed their course of radiation within 6 weeks with only 69 patients receiving the scheduled 60 Gy of external beam radiation therapy dose. Only 6 patients out of 22 completed the 6 cycles of weekly chemotherapy with compliance decreasing most after 3 cycles. Mucositis and dysphagia were significantly higher in the chemoradiation arm. After a median follow-up of 47 months, the loco-regional control rate was 51.4% in the postoperative chemoradiation arm as compared to 35.56% in the postoperative radiation arm. The 5 years overall survival was 56.4% in postoperative chemoradiation arm as compared to 51.3% in the postoperative radiation only. Conclusion: Postoperative concurrent chemoradiation with weekly cisplatin in high-risk oral cancer gave an advantage in the loco-regional control rate and overall survival at the end of 47 months, with significant increase in acute toxicities Grade III and Grade IV toxicities.