Neo-Adjuvant Chemotherapy Enables Functional Preservation in Advanced Tongue Cancers: A Retrospective Cohort Study

Background: Neo-adjuvant chemotherapy (NACT) has shown promise in reducing tumor size and in rendering onco-logically safe resections in borderline resectable head and neck cancers. In patients with squamous cell carcinoma (SCC) of the tongue, NACT may facilitate less extensive surgeries and preserve critical structures, one such being the hypo-glossal nerve. Methods: A retrospective audit was conducted of patients with tongue SCC who underwent NACT followed by surgery at our centre between May 2022 and December 2024. Outcomes of interest included tumor response, hypoglossal nerve preservation, and pathological response. Results: 31 patients requiring potential bilateral hypoglossal nerve sacrifice having a median age of 48 years were included in the analysis. All patients presented with advanced stage (Stage IVa/IVb/III) and 80.6% had clinical nodal involvement. Following NACT, 45.2% (14/31) of these patients showed sufficient tumor regression to allow for unilateral hypoglossal nerve preservation. The most common chemo-therapy regimen was DCF, with 83.9% of patients experiencing no grade III/IV toxicities. Post-NACT histopathology showed that 32.3% of patients had no residual tumor, and 93.6% achieved uninvolved margins. 32.3% of the patients achieved complete regression (Mandard Grade I). Conclusion: Functional preservation of at least one hypoglossal nerve in advanced OSCC of the tongue is feasible. In this study hypoglossal nerve preservation in nearly half of the patients with midline-crossing tumors was achieved by NACT. The favourable histopathological outcomes and manageable toxicity profiles suggest that NACT may be a viable approach for improving functional outcomes in locally advanced squamous cell carcinoma of the tongue.