Induction TPF in Oral Cavity Cancer

Evidence-Based Recommendation

The European Head and Neck Society (EHNS), European Society for Medical Oncology (ESMO), and European Society for Radiotherapy and Oncology (ESTRO) 2020 guidelines state that induction TPF chemotherapy is not recommended for oral cavity cancer and does not improve survival compared to upfront surgery followed by adjuvant therapy, with a Level I, Grade A recommendation 1, 2, 3
The EHNS-ESMO-ESTRO 2020 guidelines recommend that outside of a laryngeal-preservation strategy, the role of induction chemotherapy is not recommended for head and neck cancers, including oral cavity tumors, with a Level I, Grade A recommendation 1, 2, 3

Primary surgical treatment followed by adjuvant radiotherapy or chemoradiotherapy is the preferred treatment for T3/T4 oral cavity cancers, according to the EHNS-ESMO-ESTRO 2020 guidelines 3, 4
Single-modality treatment with surgery or radiotherapy is recommended for early stage disease (T1-T2, N0-N1), with conservative surgery (transoral laser microsurgery or transoral robotic surgery) preferred 4
Primary surgical resection followed by risk-adapted adjuvant therapy is recommended for locally advanced disease (T3-T4 or N2-N3), with postoperative radiotherapy (58-64 Gy) for pT3-4 tumors, perineural infiltration, lymphovascular invasion, or >1 positive node 2, 3, 4
Postoperative chemoradiotherapy (66 Gy with cisplatin 100 mg/m² every 3 weeks) is recommended for R1 resection or extracapsular extension 2, 4, 5

TPF is the standard induction regimen only for laryngeal or hypopharyngeal cancer in organ-preservation strategies, according to the EHNS-ESMO-ESTRO 2020 guidelines 1, 2, 3
The biology and treatment paradigms for oral cavity cancers are fundamentally different from those for laryngeal preservation, and delaying surgery with ineffective induction chemotherapy increases morbidity and mortality without improving outcomes 1