Lonare Siddharth B, Babu V Manoj, Sharma Rajat, Chendkapure Krunal A, Velip Abhijeet S, Bind Nirbhay
General Surgery, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, Pune, IND.
General Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND.
Cureus. 2024 Oct 30;16(10):e72680. doi: 10.7759/cureus.72680. eCollection 2024 Oct.
Objective This study aims to compare the efficacy of neoadjuvant methotrexate therapy followed by surgery versus primary surgical management in patients with stage III oral carcinoma. Methods Thirty patients diagnosed with stage III oral carcinoma were enrolled in this prospective study at a tertiary cancer research center. The patients were divided into two groups: 15 patients received neoadjuvant methotrexate therapy followed by surgery, while 15 underwent primary surgical management. Outcomes were evaluated based on tumor downstaging, surgical margins, postoperative complications, and the requirement for adjuvant radiotherapy. Results Patients in the neoadjuvant methotrexate group demonstrated significant tumor downstaging, allowing for less extensive surgical procedures, with 33.3% (n=5) undergoing wide local excision (WLE) compared to 13.3% (n=2) in the primary surgery group. Negative surgical margins were achieved in 93.33% (n=14) of patients in the neoadjuvant group versus 53.33% (n=8) in the surgical group. Additionally, only 13.3% (n=1) of patients in the neoadjuvant group required postoperative radiotherapy, compared to 53.33% (n=8) in the surgical group. The recurrence rate over a six-month follow-up period was comparable between the two groups. Discussion Neoadjuvant methotrexate therapy resulted in better surgical and oncological outcomes by downstaging the tumor, reducing the extent of surgery, and minimizing the need for postoperative radiotherapy. The findings suggest that methotrexate, as a neoadjuvant agent, is effective in improving patient outcomes with fewer side effects compared to standard cisplatin-based regimens. Conclusion Neoadjuvant methotrexate therapy offers a viable treatment option for stage III oral carcinoma, demonstrating improved oncological and surgical outcomes, including less invasive surgery, higher rates of negative surgical margins, and reduced postoperative radiotherapy requirements. Further research with long-term follow-up is necessary to validate these findings and explore the long-term impact on survival and recurrence rates.
目的 本研究旨在比较新辅助甲氨蝶呤治疗后手术与一期手术治疗Ⅲ期口腔癌患者的疗效。方法 在一家三级癌症研究中心，30例被诊断为Ⅲ期口腔癌的患者被纳入这项前瞻性研究。患者被分为两组：15例患者接受新辅助甲氨蝶呤治疗后手术，而另外15例接受一期手术治疗。基于肿瘤降期、手术切缘、术后并发症以及辅助放疗需求对结果进行评估。结果 新辅助甲氨蝶呤组患者显示出显著的肿瘤降期，使得手术范围得以缩小，33.3%（n = 5）的患者接受了广泛局部切除（WLE），而一期手术组为13.3%（n = 2）。新辅助组93.33%（n = 14）的患者实现了阴性手术切缘，手术组为53.33%（n = 8）。此外，新辅助组仅13.3%（n = 1）的患者需要术后放疗，手术组为53.33%（n = 8）。两组在六个月随访期内的复发率相当。讨论 新辅助甲氨蝶呤治疗通过使肿瘤降期、减少手术范围并最小化术后放疗需求，带来了更好的手术和肿瘤学结果。研究结果表明，与基于顺铂的标准方案相比，甲氨蝶呤作为新辅助药物在改善患者结局方面有效且副作用更少。结论 新辅助甲氨蝶呤治疗为Ⅲ期口腔癌提供了一种可行的治疗选择，显示出改善的肿瘤学和手术结果，包括侵入性较小的手术、更高的阴性手术切缘率以及更低的术后放疗需求。需要进行长期随访的进一步研究来验证这些发现，并探索其对生存率和复发率的长期影响。
