Response‐Adapted Surgery Following Neoadjuvant Chemotherapy in Oral Cavity Squamous Cell Carcinoma: An Era‐Based Retrospective Cohort Study
Shreya Rai, Mudit Agarwal, Abhishek Singh, Pradyumna Singh, Kshitiz Bansal, P. Karthik, Abhishek Gugliani, Neha Garg, P. Leela, Sarthak Tandon, Jitin Goyal, Manoj Gupta, Rashmi Bansal, Rajat Saha, Parveen Ahlawat, Sunil Pasricha, Munish GairolaABSTRACT
Background
Evidence regarding response‐adapted resection after neoadjuvant chemotherapy (NACT) in oral cavity squamous cell carcinoma remains limited.
Methods
We compared conventional‐era (2018–2021) and response‐adapted‐era (2022–2024) surgery after NACT. Margins, recurrence, 2‐year survival, and surgical outcomes were assessed.
Results
Among 129 patients (58 conventional; 71 response‐adapted), positive margins occurred in 3.4% versus 1.4% and local recurrence in 12.1% versus 7.0%. Two‐year disease‐free survival (DFS) was 56.6% versus 67.8% (log‐rank p = 0.135). Adjusted DFS HR for the response‐adapted era was 0.54 (95% CI 0.28–1.04; p = 0.066). ENE predicted inferior DFS (HR 3.60; p < 0.001). Responder‐only analysis showed no significant survival difference.
Conclusions
No observed increase in positive margins or local recurrence accompanied the later surgical strategy. Retrospective selection, unequal follow‐up, and limited events preclude conclusions of noninferiority or a causal survival benefit.