# Should Super-Selective Intra-Arterial Chemoradiotherapy Be Prioritized over Surgical Resection for Locally Advanced Oral Cavity Cancer?

## TL;DR

This study compares two treatments for advanced oral cavity cancer and finds that super-selective intra-arterial chemoradiotherapy offers similar survival but better quality of life than surgery.

## Contribution

The study provides the first propensity score-matched comparison of SSIACRT and surgical resection for oral cavity cancer.

## Key findings

- SSIACRT showed a 5-year disease-specific survival rate of 71.3% compared to 52.4% for surgical resection.
- SSIACRT significantly improved quality of life in appearance, swallowing, speech, and other domains.
- Survival rates were comparable between the two treatments, but SSIACRT was associated with better functional outcomes.

## Abstract

Treatment of locally advanced oral cavity cancer remains controversial. The standard of care—surgical resection with adjuvant therapies—has not led to significant improvements in overall survival or quality of life, despite advances in radical or invasive treatment and reconstructive techniques. Super-selective intra-arterial chemoradiotherapy (SSIACRT) has emerged as an alternative treatment and has shown outcomes comparable to conventional standard care; however, comparative studies are lacking, and this modality remains less established. To evaluate the efficacy of SSIACRT, we conducted a retrospective study comparing SSIACRT and surgical resection with adjuvant therapies in terms of prognosis and functional outcomes in patients with stage III and IV locally advanced oral cavity cancer. Our findings indicate that SSIACRT is associated with better outcomes, particularly with respect to postoperative quality of life, compared with conventional radical surgical treatment.

Background/Objectives: Super-selective intra-arterial chemoradiotherapy (SSIACRT) is an alternatively effective treatment for locally advanced oral cavity cancer although no comparative studies on prognosis between SSIACRT and surgical resection with or without post-operative radiotherapy (S+R) have been reported. This study aimed to compare the 5-year survival rate and Quality of Life (QoL) between S+R and SSIACRT for locally advanced oral cavity cancer. Methods: From a total of 326 patients with stage III and IV oral cavity cancer treated between 2000–2020 at a single institution, 149 patients treated with S+R and SSIACRT were analyzed by using Propensity Score Matching (PSM) method, a pseudo-randomized controlled trial, and the matched cases were retrospectively evaluated. The 5-year survival rate and QoL were evaluated using the Kaplan–Meier method and the University of Washington QoL questionnaire, respectively. Log-rank test and Cox proportional hazards model were used to compare 5-year survival rate and to assess factors affecting survival rates, respectively. Paired t-test was used to compare QoL. Results: To compare the 5-year survival rate and QoL between S+R and SSIACRT, 48 and 15 cases were matched after PSM. The 149 cases were further evaluated for covariates affecting survival rates. The 5-year disease-specific survival rate and 5-year crude survival rate were 52.4% and 44.3% for S+R and 71.3%, and 62.9% for SSIACRT, respectively. There was no statistical difference in survival rates between both treatments, based on Log-rank test analysis. Treatment method was the only independent variable that influenced survival rates. SSIACRT showed better statistical difference in QoL evaluation, specifically in appearance, activity, recreation, swallowing, speech, shoulder, taste, mood, and total score. Conclusions: Propensity score-matched analysis demonstrated survival outcomes that were comparable to, and not inferior to, S+R. However, SSIACRT was associated with superior quality-of-life outcomes compared with S+R, as shown by Cox proportional hazards modeling. These findings suggest that SSIACRT is an effective treatment option and, from a quality-of-life perspective, may be considered a preferable approach in the management of locally advanced oral cavity cancer.