Efficacy of neoadjuvant chemotherapy in patients with oral squamous cell carcinoma in a few selected centres in Klang Valley, Malaysia / Norul Mashirah Mohd Noor
INTRODUCTION: Neoadjuvant chemotherapy (NAC) is purportedly advantageous in tumour reduction before definitive surgery is performed, with or without subsequent radiotherapy. Over the years, there have been conflicting results on the efficacy of NAC in advanced head and neck cancer, especially in...
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| Format: | Thesis |
| Published: |
2019
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| Online Access: | http://studentsrepo.um.edu.my/11218/4/norul.pdf http://studentsrepo.um.edu.my/11218/ |
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| Summary: | INTRODUCTION: Neoadjuvant chemotherapy (NAC) is purportedly advantageous in
tumour reduction before definitive surgery is performed, with or without subsequent
radiotherapy. Over the years, there have been conflicting results on the efficacy of NAC
in advanced head and neck cancer, especially in oral cavity cancer. As the practice of
NAC for oral squamous cell carcinoma (OSCC) is relatively new in Malaysia, there is a
need to analyse the effectiveness of this treatment in the local settings for clinicians to
consider NAC as a viable treatment option in future. This study aims to assess the
effectiveness of NAC in patients with OSCC in Malaysia through histological assessment
and podoplanin (PDPN) and VEGF expression. METHODOLOGY: For 14 OSCC
patients treated with NAC, and subsequently surgery, tumour regression grading was
performed using Tumour Regression Systems (Mandard-TRG, Ryan-TRG and AJCCTRG) on all surgically excised tumour specimen slides. The corresponding pre-treatment
biopsy specimens were investigated for Podoplanin and VEGF expression through
immunohistochemistry. RESULTS: Only 2 out of 14 cases showed complete tumour
regression while 9 cases had mild to absence of regression. AJCC-TRG was significantly
correlated with larger tumour size (ypT) (p=0.001) and strongly associated with advanced
stage, positive margin, positive lymph node metastasis, extracapsular spread and poorly
differentiated tumour. High expression of PDPN was observed in cases with mild to
absence of tumour regression while VEGF expression demonstrated no correlation with
tumour regression. CONCLUSION: NAC did not offer added benefit as a treatment
option for OSCC. AJCC-TRG system is recommended in grading tumour response in
NAC-treated head and neck cancer and OSCC. PDPN showed potential as prognosticator
for OSCC and as predictor of poor tumour response to NAC. VEGF was neither a good
predictor of tumour response to NAC nor a promising prognosticator for OSCC.
iv
Keywords: OSCC, Neoadjuvant chemotherapy, Tumour Regression Grading,
Podoplanin, VEGF. |
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