Swasthik Upadhya

Background: Though neoadjuvant chemotherapy (NACT) has not improved survival in oral cancers, its role in tongue cancer remains uncertain. Methods: This was a retrospective study of patients with locally advanced oral tongue cancer (Stage III–IVB) to assess response rates, mandibular preservation, and surgical extent post‐NACT, along with recurrence and survival outcomes. Results: Of 72 patients, 20 (27.8%) received NACT, while 52 (72.2%) underwent upfront surgery. In the NACT group, 15 (75%) received TPF chemotherapy for a median of 3 cycles. One patient (5%) had a complete response, and 13 (65%) had a partial response. The clinical benefit rate was 85%. Tumor downstaging occurred in 14 (70%) patients, with 6 (42.9%) requiring less extensive surgery. The mandibular preservation rate was 75%. The pathological complete response was 10%. Local and distant control rates, disease‐free survival, and overall survival were comparable. Conclusion: Despite its retrospective design and small sample size, this study suggests that NACT can downstage tumors, improve response rates, and enable less extensive surgery in locally advanced tongue cancer.

Purpose: Fibro-adipose vascular anomaly (FAVA) is a unique lesion composed of dense fibro-fatty tissue and slow-flow vascular malformations and is associated with somatic PIK3CA mutations. The patient usually presents with pain, swelling, functional restriction, and skin hyperesthesia. Therapeutic armamentarium includes cryoablation, sirolimus, and surgical debulking/excision. Sirolimus is highly effective for treatment of FAVA and is well tolerated. Here, we report our experience of treating FAVA with sirolimus in 3 patients. Methods: We retrospectively reviewed data of 3 patients with FAVA who were treated with sirolimus at our institution. Results: A total of 3 patients with FAVA being managed with sirolimus were assessed. Two out of 3 were male. The ages of the patients were 2, 12, and 17 years respectively. Sirolimus was started at a dose of 0.8 mg/m²/dose two times a day, and patients were treated for a mean of 10.6 months (range 10–11 months). Dose adjustments were made to keep trough serum levels between 5 and 12 ng/ml. All of them had reduction in pain, and 1 of them experienced it within 4 days of therapy initiation. Follow-up MRI revealed reduction in size in all 3 patients. Sirolimus was well tolerated with mild acne and dyslipidaemia being the only side effects observed. Conclusion: Sirolimus is quite an effective treatment for patients with FAVA and is well-tolerated without any major adverse effects. Given the rapid responses and a favourable safety profile, we believe that sirolimus can be considered for all patients with FAVA as a first-line therapy, but long-term follow-up data from well-designed clinical trials are required.