Oral oncology · 2026
Characterization of response-adapted surgery following neoadjuvant systemic therapy in oral cavity cancer.
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Lu Richard J, Dunn Lara, Tam Kenric, Starc Michael T, Wong Richard J, Ganly Ian, Patel Snehal, Lee Nancy, Wong Winston, Cohen Marc A, Ho Alan, Cracchiolo Jennifer R
Аннотация
OBJECTIVES: Despite decades of experience with neoadjuvant systemic therapy (NST) in oral cavity squamous cell carcinoma (OCSCC) demonstrating its potential to facilitate surgical de-escalation through tumor downstaging, the impact of NST on response-adapted surgery has not been systematically evaluated.
MATERIALS AND METHODS: Surgical de-escalation following neoadjuvant NST was quantified using the Response-Adapted Surgery-Oral Cavity classification and the Oral Cavity Surgical Morbidity Score (OC-SMS) in 70 consecutive patients with resectable, locally advanced OCSCC. The relationship between surgical de-escalation, pathologic response, and margin status was assessed.
RESULTS: Surgical de-escalation was observed in 44 patients (62.8 %). Mean OC-SMS decreased from 9.1 (95 % CI, 8.5-9.7) before NST to 6.5 (95 % CI, 5.8-7.3) after NST. The largest contributors to de-escalation were reduced extent of resection (52 %), decreased need for free flap reconstruction (27 %), reduced surgical access requirements (17 %), and less extensive neck dissection (3 %). The greatest reductions were observed in tongue cancers (mean decrease, 3.1 points; p < 0.001), followed by buccal mucosa (2.1 points; p = 0.024) and floor of mouth cancers (2.0 points; p = 0.250). Gingival cancers demonstrated the smallest reduction (1.1 points; p = 0.116). Surgical de-escalation correlated with pathologic response, and 97 % of de-escalated cases achieved negative margins.
CONCLUSION: Neoadjuvant systemic therapy resulted in measurable surgical de-escalation in OCSCC without compromising margin status. Surgical de-escalation should be incorporated as a key endpoint in future prospective trials designed to optimize NST approaches.
MATERIALS AND METHODS: Surgical de-escalation following neoadjuvant NST was quantified using the Response-Adapted Surgery-Oral Cavity classification and the Oral Cavity Surgical Morbidity Score (OC-SMS) in 70 consecutive patients with resectable, locally advanced OCSCC. The relationship between surgical de-escalation, pathologic response, and margin status was assessed.
RESULTS: Surgical de-escalation was observed in 44 patients (62.8 %). Mean OC-SMS decreased from 9.1 (95 % CI, 8.5-9.7) before NST to 6.5 (95 % CI, 5.8-7.3) after NST. The largest contributors to de-escalation were reduced extent of resection (52 %), decreased need for free flap reconstruction (27 %), reduced surgical access requirements (17 %), and less extensive neck dissection (3 %). The greatest reductions were observed in tongue cancers (mean decrease, 3.1 points; p < 0.001), followed by buccal mucosa (2.1 points; p = 0.024) and floor of mouth cancers (2.0 points; p = 0.250). Gingival cancers demonstrated the smallest reduction (1.1 points; p = 0.116). Surgical de-escalation correlated with pathologic response, and 97 % of de-escalated cases achieved negative margins.
CONCLUSION: Neoadjuvant systemic therapy resulted in measurable surgical de-escalation in OCSCC without compromising margin status. Surgical de-escalation should be incorporated as a key endpoint in future prospective trials designed to optimize NST approaches.