Surgery Following Failure of Repeated Chemotherapy for Squamous Cell Carcinoma of the Tongue can be Fatal and Futile

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SquamousCell Carcinoma of the Oral Cavity (OSCC) has a strong presence in this part of the world – with the 2012 GLOBOCAN estimates reporting the highest age-standardized rate, with respect to the world population, in the World Health Organization (WHO) South-East Asia region (6.0 per 100,000). OSCC is known to carry high mortality and morbidity, with various cohorts having described five-year Overall Survival (OS) between 36.1% to 62.5%, and complications rates ranging from 47% to 62%. The tongue is the most common subsite in OSCC.

Surgery has been established as the treatment of choice in OSCC, with chemotherapy and radiotherapy largely being used in the adjuvant setting for patients with specific risk features, and in the palliative setting for patients with recurrent or unresectable disease. Multidisciplinary care is imperative for ensuring favorable outcomes. Nevertheless, some patients seek alternative non-surgical treatment in the primary setting due to concerns of surgical morbidity and its impact on essential functions of eating, drinking, chewing, swallowing, and speaking.

While it is understandable that concerns arising from potential surgical morbidity may deter patients from accepting treatment upfront, non-surgical treatment in the primary setting for resectable OSCC has been associated with poorer outcomes. There is little published data on the outcomes of patients who avoid surgery and instead undergo multiple cycles of non-surgical treatment for OSCC.