Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2016; 05(02): 052-055
DOI: 10.4103/2278-330X.181625
METRONOMIC THERAPY IN HEAD AND NECK CANCERS : Original Article

Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: A retrospective study from rural India

Avinash Pandey
Department of Medical Oncology, Tata Memorial Hospital, Mumbai
Department of Medical Oncology BKLWH, Ratnagiri, Maharashtra
Department of Radiation Oncology, BKLWH, Ratnagiri, Maharashtra
,
A. Desai
Department of Surgical Oncology, BKLWH, Ratnagiri, Maharashtra
,
V. Ostwal
Department of Medical Oncology, Tata Memorial Hospital, Mumbai
,
V. Patil
Department of Medical Oncology, Tata Memorial Hospital, Mumbai
,
A. Kulkarni
Department of Radiation Oncology, BKLWH, Ratnagiri, Maharashtra
,
R. Kulkarni
Department of Pathology, BKLWH, Ratnagiri, Maharashtra
,
N. Patil
Department of Radiodiagnosis, BKLWH, Ratnagiri, Maharashtra
,
D. Chaukar
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
,
K. Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai
,
Shripad D. Banavali
Department of Medical Oncology, Tata Memorial Hospital, Mumbai
› Author Affiliations Financial support and sponsorship: Nil.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Background: Oral cavity cancer is the most common cancer among rural India. There is a paucity of data for outcomes of operable oral cavity cancer from rural India. Use of maintenance metronomic may delay or avoid relapse. Aim: To evaluate outcomes of operable oral cavity carcinoma and evaluate impact of maintenance metronomic chemotherapy. Objectives: To evaluate disease-free survival (DFS), overall survival (OS), and factors affecting the outcome in operable oral cavity cancer. Materials and Methods: Data of patients diagnosed with oral cavity cancer registered between May 2008 and May 2014 were retrieved. Only those patients with operable oral cavity cancer and upfront definitive surgery were included in the study. Demographic profile, stage, tobacco consumption, adjuvant therapy, and pattern of failure were collected. Kaplan-Meir survival analysis was used to determine DFS and OS. Log-rank test was used to evaluate factors affecting outcome. Results: Median follow-up is 24 months. Out of 335 patients, 225 (67%) had advanced operable cancer with 42/225 (18%) and 183/225 (82%) as Stages III and IVA, respectively. Buccal mucosa was the most common subsite (178/335, 53%) followed by tongue (63/335, 19%). Ninety-two percent patients were addicted to smokeless tobacco, whereas 27% were smokers. Median DFS is 13 months with 2 years relative DFS 32%. Median OS is 30 months, with 2 years OS of 54%. Metronomic adjuvant oral chemotherapy was given in 130/225 (58%); Stage III and IVA patients with median of 14 months (3-18 months). Use of metronomic chemotherapy improved DFS (8 vs. 14 months, P = 0.22) and OS (14 vs. 26 months, P = 0.04). Conclusion: Oral cavity cancer is a major health care problem in rural India. Presentation at advanced stage leads to suboptimal outcomes. Benefit of metronomic maintenance chemotherapy in locally advanced oral cavity needs to be further evaluated prospectively.

Key words

Locally advanced head and neck squamous cell carcinoma - maintenance metronomic - oral cavity


Publication History

Article published online:
28 December 2020

© 2016. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.
  • 2 Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.
  • 3 Kumar S, Heller RF, Pandey U, Tewari V, Bala N, Oanh KT. Delay in presentation of oral cancer: A multifactor analytical study. Natl Med J India 2001;14:13-7.
  • 4 Conway DI, Petticrew M, Marlborough H, Berthiller J, Hashibe M, Macpherson LM. Socioeconomic inequalities and oral cancer risk: A systematic review and meta-analysis of case-control studies. Int J Cancer 2008;122:2811-9.
  • 5 Sunny L, Yeole BB, Hakama M, Shiri R, Sastry PS, Mathews S, et al. Oral cancers in Mumbai, India: A fifteen years perspective with respect to incidence trend and cumulative risk. Asian Pac J Cancer Prev 2004;5:294-300.
  • 6 Thorat RV, Panse NS, Budukh AM, Dinshaw KA, Nene BM, Jayant K. Prevalence of tobacco use and tobacco-dependent cancers in males in the rural cancer registry population at Barshi, India. Asian Pac J Cancer Prev 2009;10:1167-70.
  • 7 De Felice F, Musio D, Tombolini V. Head and neck cancer: Metronomic chemotherapy. BMC Cancer 2015;15:677.
  • 8 Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945-52.
  • 9 Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937-44.
  • 10 Noronha V, Joshi A, Marfatia S, Patil V, Juvekar S, Arya S, et al. Health-related quality of life in patients with metastatic, relapsed, or inoperable squamous cell carcinoma of the head and neck in India. Support Care Cancer 2016;24:1595-602.
  • 11 Patil VM, Noronha V, Joshi A, Muddu VK, Dhumal S, Bhosale B, et al. A prospective randomized phase II study comparing metronomic chemotherapy with chemotherapy (single agent cisplatin), in patients with metastatic, relapsed or inoperable squamous cell carcinoma of head and neck. Oral Oncol 2015;51:279-86.
  • 12 Patil VM, Noronha V, Joshi A, Pinninti R, Dhumal S, Bhattacharjee A, et al. Metronomic chemotherapy in platinum-insensitive failures and/or early failures postmultimodality management in oral cancers. Indian J Med Paediatr Oncol 2015;36:161-5.
  • 13 Hanahan D, Bergers G, Bergsland E. Less is more, regularly: Metronomic dosing of cytotoxic drugs can target tumor angiogenesis in mice. J Clin Invest 2000;105:1045-7.
  • 14 Browder T, Butterfield CE, Kräling BM, Shi B, Marshall B, O′Reilly MS, et al. Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 2000;60:1878-86.
  • 15 Pasquier E, Kavallaris M, André N. Metronomic chemotherapy: New rationale for new directions. Nat Rev Clin Oncol 2010;7:455-65.
  • 16 Ko SH, Choi GJ, Lee JH, Han YA, Lim SJ, Kim SH. Differential effects of selective cyclooxygenase-2 inhibitors in inhibiting proliferation and induction of apoptosis in oral squamous cell carcinoma. Oncol Rep 2008;19:425-33.
  • 17 Bock JM, Menon SG, Sinclair LL, Bedford NS, Goswami PC, Domann FE, et al. Celecoxib toxicity is cell cycle phase specific. Cancer Res 2007;67:3801-8.
  • 18 Patil V, Noronha V, D′cruz AK, Banavali SD, Prabhash K. Metronomic chemotherapy in advanced oral cancers. J Cancer Res Ther 2012;8 Suppl 1:S106-10.
  • 19 Patil V, Noronha V, Krishna V, Joshi A, Prabhash K. Oral metronomic chemotherapy in recurrent, metastatic and locally advanced head and neck cancers. Clin Oncol (R Coll Radiol) 2013;25:388.
  • 20 Pai PS, Vaidya AD, Prabhash K, Banavali SD. Oral metronomic scheduling of anticancer therapy-based treatment compared to existing standard of care in locally advanced oral squamous cell cancers: A matched-pair analysis. Indian J Cancer 2013;50:135-41.
  • 21 André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low-income and middle-income countries? Lancet Oncol 2013;14:e239-48.
  • 22 Metronomic Chemotherapy with Tegafur/Uracil for Head and Neck Squamous Cell Carcinoma. Available from: http://www.clinicaltrials.gov/ct2/show/study/NCT00855881?show_desc=Y#desc. [Last accessed on 2016 Apr 03].