D . Mohamed Ib ahim, e al. T ea men package ime in o al ca i y cance pa ien s in egional cance cen e in
Sou h Tamil Nadu-A p ospec i e c oss-sec ional s udy. In . J Med. Pha m. Res., 6 (6): 379-383, 2025
379
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
T ea men package ime in o al ca i y cance pa ien s in egional
cance cen e in Sou h Tamil Nadu-A p ospec i e c oss-sec ional s udy
¹D . Mohamed Ib ahim Ma oo , ²D . Ramesh Mu hu el, ³D . Balasub amaniam, ⁴D . AN Gu umoo hy, ⁵D . M
Sa ishkuma
1, 3, 4, 5Depa men o Su gical Oncology, Madu ai Medical College and Hospi al, Madu ai, Tamil Nadu, India
2P o esso , Depa men o Su gical Oncology, Madu ai Medical College and Hospi al, Madu ai, Tamil Nadu, India
A B S T R A C T
Co esponding Au ho :
D . Ramesh Mu hu el
P o esso , Depa men o Su gical
Oncology, Madu ai Medical
College and Hospi al, Madu ai,
Tamil Nadu, India
Recei ed: 03-09-2025
Accep ed: 21-10-2025
A ailable online: 16-11-2025
Backg ound: O al ca i y squamous cell ca cinoma (OCSCC) is a majo heal h
conce n in India, wi h o e 75% o pa ien s p esen ing wi h locally ad anced
disease. Combined modali y ea men wi h su ge y ollowed by adju an
adio he apy imp o es su i al ou comes. Timely ini ia ion o adio he apy, ideally
wi hin six weeks o su ge y, and a T ea men Package Time (TPT) he o al in e al
om he da e o su ge y o he comple ion o adio he apy unde 100 days a e
conside ed c i ical o op imal ou comes.
Me hods: A p ospec i e coho s udy was conduc ed a Madu ai Medical College,
Regional Cance Cen e du ing No embe 2023 o No embe 2024 in i y pa ien s
wi h his ologically con i med OCSCC who unde wen su gical esec ion ollowed
by planned adju an adio he apy. Fou pa ien s who did no comple e adio he apy
we e excluded. Demog aphic da a, umo cha ac e is ics, Su gical ype and
adio he apy iming, and TPT we e compa ed and analysed.
Resul s: Among he 46 pa ien s, 65.2% we e male, and 91.4% had a his o y o
obacco use. The mos common umo si es we e buccal mucosa (37.0%) and
ongue (30.4%). Ad anced-s age umo s (T3-T4a) we e obse ed in 71.7% o
pa ien s, wi h nodal in ol emen in 67.4%. Only 30.4% ini ia ed adio he apy
wi hin six weeks o su ge y. TPT was ≤100 days in 52.2% o pa ien s, while 47.8%
exceeded his du a ion. Flap econs uc ion was pe o med in 74.0% o pa ien s;
al hough mo e pa ien s in his g oup comple ed ea men wi hin 100 days, he
associa ion was no s a is ically signi ican (p = 0.129).
Conclusion: A subs an ial p opo ion o OCSCC pa ien s expe ienced delays in
adju an adio he apy and p olonged TPT. E o s o s eamline pos ope a i e ca e
and educe delays a e essen ial o imp o e ea men ou comes.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: O al ca i y cance , ea men package ime, adio he apy delay,
su gical oncology, squamous cell ca cinoma, adju an he apy, head and neck
cance , India
In oduc ion
O al ca i y cance cons i u es majo heal h bu den in he wo ld wi h incidence o 3 lakh new cases pe yea and 1.5 lakh
people succumbing o he disease [1]. In India, i is es ima ed ha annually he e a e app oxima ely 77,000 inciden cases
and 52,000 dea hs due o o al cance , accoun ing o abou one- ou h o global incidences [2]. This shows he e is end
owa ds inc ease in he incidence, whe eas he mo ali y emains he s able. Indian da a shows abou 75% o pa ien s p esen
in locally ad anced and ad anced s age and equi ing he need o combined modali y ea men . The ising incidence o
o al cance poses a c i ical conce n o communi y heal h, gi en i s p e alence as one o he mos common ypes o cance
in he coun y. The i e-yea ela i e su i al a e o o al cance s ands a 68.0% in de eloped coun ies [3]. In con as , in
India, i is app oxima ely 50% ollowing ea men wi h su ge y and adio he apy, signi ican ly lowe han in many
de eloped na ions [4]. Su i al o ea ly-s age o al ca i y cance is a ound 70-85%, when s age ad ances, su i al d ops o
less han 50%. When combined modali y ea men is added, su i al is a ound 50-60% o locally ad anced o al ca i y
cance [5]. The de elopmen o OSCC is a mul is ep p ocess which s a s om some changes in he no mal mucosa and
con inues un il he de elopmen o in asi e cance and me as asis. Du ing his p og ess, he accumula ion o mul iple
D . Mohamed Ib ahim, e al. T ea men package ime in o al ca i y cance pa ien s in egional cance cen e in
Sou h Tamil Nadu-A p ospec i e c oss-sec ional s udy. In . J Med. Pha m. Res., 6 (6): 379-383, 2025
380
gene ic and ch omosomal al e a ions occu s. O al cance is a mul i ac o ial disease and he isk ac o s include obacco and
alcohol, ch onic in lamma ion, ul a iole (UV) adia ion ( o lip cance ), human papilloma i us (HPV) o Candida
in ec ions, immunosupp ession, gene ic p edisposi ion, and die . [6]. Among hem, obacco use and alcohol consump ion
a e conside ed as he main isk ac o s o de elopmen o al ca i y Cance and bo h ha e he syne gis ic e ec . Recen
e idence shows in pa ien s unde going su ge y ollowed by adju an adio he apy, he de imen al impac o p olonging
he ea men du a ion has been epo ed. Well-de ined T ea men du a ion pa ame e s include in e al om su ge y o
adio he apy commencemen , o e all adia ion du a ion ( i s o las day o adia ion cou se) and T ea men Package Time
(TPT) which encompasses he ime ame om he day o su gical esec ion ill he las adia ion ac ion. The Na ional
Comp ehensi e Cance Ne wo k (NCCN) endo sed he ecommenda ion o s a adju an Radia ion wi hin six weeks om
su ge y [7]. Op imal T ea men package ime (TPT) cu -o a ied be ween di e en s udies wi h ange o a ound 100 days
in classic s udies. Any delay in TPT would no add bene i s o adju an adio he apy, would esul in high ecu ence and
low su i al a es wi h addi ional mo bidi y o adio he apy [8]. Ou s udy aims o s udy T ea men o Package Time o o al
ca i y squamous ca cinoma Pa ien s in Regional Cance Cen e in Sou h Tamil Nadu and ac o s con ibu ing o he delay.
Me hodology
A coho o 50 pa ien s diagnosed wi h o al ca i y squamous cell ca cinoma (OSCC) who unde wen su ge y ollowed by
adju an adio he apy a ou ins i u e be ween No embe 2023 o No embe 2024 we e included in he s udy. Pa ien who
had any p eope a i e ea men , ecu en o second p ima y we e excluded om he s udy. Sample size o 50 was
calcula ed by sampling me hod o con enience. Da a collec ed includes demog aphic de ails, in ol ed o al ca i y subsi e,
ype o su ge y pe o med, pos ope a i e complica ions, he in e al be ween su ge y and ini ia ion o adio he apy, o e all
ea men package ime, and any delays along wi h hei easons. Da a en y was pe o med using Mic oso Excel, and
s a is ical analysis was ca ied ou using he S a is ical Package o Social Sciences (SPSS) so wa e, e sion 20. Quali a i e
a iables we e exp essed as equencies and pe cen ages. No mally dis ibu ed con inuous a iables we e p esen ed as
mean ± s anda d de ia ion (SD), while non-no mally dis ibu ed a iables we e exp essed as medians. Ca ego ical a iables
we e analysed using he Chi-squa e es o Fishe 's exac es , as app op ia e and s a is ical signi icance was de e mined
acco dingly.
Resul s
Pa ien demog aphics da a, isk ac o s, clinical cha ac e is ics, pa hological da a, ea men de ails, adio he apy ini ia ion
pe iod, T ea men Package Time (TPT) a e summa ized in Table 1. As shown, s udy comp ise o 50 pa ien s in whom 4
pa ien s did no comple e he adju an adio he apy we e no included. The majo i y o he coho we e male (65.2%), wi h
emales comp ising 34.8%. A signi ican p opo ion o pa ien s had a his o y o obacco use, ei he in o m o smoking
(45.7%) o chewing obacco (45.7%).In ou s udy, he mos commonly a ec ed subsi e was he buccal mucosa, accoun ing
o 37.0% o cases, ollowed by he ongue (30.4%). O he less equen subsi es include loo o mou h (10.9%), lip (8.7%),
al eolus (6.5%), ha d pala e (4.3%), and e omola igone (2.2%).
In e ms o umo s aging, a conside able numbe o pa ien s p esen ed wi h ad anced p ima y umo s. T4a s age was no ed
in 39.1% o cases, ollowed by T3 in 32.6% and T2 in 28.3% in ou s udy. Nodal in ol emen was p esen in he majo i y
o pa ien s. While 32.6% had no nodal disease (N0), he emainde showed a ying deg ees o nodal me as asis: N1 in
26.1%, N2b in 26.1%, N2c in 6.5%, N2a in 2.2%, and N3b in 6.5%.
Wi h ega d o adju an ea men imelines, only 30.4% o pa ien s we e able o ini ia e adio he apy wi hin he
ecommended 6 weeks ollowing su ge y. The ea men package ime (TPT), de ined as he in e al om he da e o
su ge y o he comple ion o adio he apy, was less han 100 days in 52.2% o pa ien s, while he emaining 47.8%
expe ienced a delay beyond 100 days. Flap econs uc ion was pe o med in 37 pa ien s (74.0%), while 13 pa ien s (26.0%)
unde wen su ge y wi hou lap co e age. Among pa ien s wi h lap econs uc ion, 58.8% comple ed ea men wi hin 100
days compa ed o 33.3% in he non- lap g oup (Table 2, 3). Howe e , his di e ence was no s a is ically signi ican (p =
0.129).
Table 1: Pa ien demog aphic and clinical pa ame e s
Numbe o Cases
Pe cen age
Sex
Female
16
34.8%
Male
30
65.2%
Smoking
No
25
54.3%
Yes
21
45.7%
obacco chew
No
25
54.3%
Yes
21
45.7%
Si e
Al eolus
3
6.5%
Buccal mucosa
17
37.0%
Floo o mou h
5
10.9%
Ha d pala e
2
4.3%
Lip
4
8.7%
Re omola igone
1
2.2%
Tongue
14
30.4%
D . Mohamed Ib ahim, e al. T ea men package ime in o al ca i y cance pa ien s in egional cance cen e in
Sou h Tamil Nadu-A p ospec i e c oss-sec ional s udy. In . J Med. Pha m. Res., 6 (6): 379-383, 2025
381
T_S age
T2
13
28.3%
T3
15
32.6%
T4a
18
39.1%
N_S age
0
15
32.6%
1
12
26.1%
2
1
2.2%
2b
12
26.1%
2c
3
6.5%
3b
3
6.5%
RT Inia ion less han 6 weeks
No
32
69.6%
Yes
14
30.4%
TPT
<100
24
52.2%
>100
22
47.8%
Table 2: Co- ela ion be ween Flap su ge y and TPT
TPT
P alue
<100
>101
Coun
Row N%
Coun
Row N%
Flap
No
4
33.3%
8
66.7%
0.129
Yes
20
58.8%
14
41.2%
Table 3: Co- ela ion be ween clinico-pa hological ac o s and TPT
TPT
P alue
<100
>100
Coun
Row N%
Coun
Row N%
Sex
Female
7
43.8%
9
56.3%
0.404
Male
17
56.7%
13
43.3%
Smoking
No
12
48.0%
13
52.0%
0.536
Yes
12
57.1%
9
42.9%
obacco chew
No
14
56.0%
11
44.0%
0.571
Yes
10
47.6%
11
52.4%
Si e
Al eolus
0
0.0%
3
100.0%
0.011
Buccal mucosa
8
47.1%
9
52.9%
Floo o mou h
0
0.0%
5
100.0%
Ha d pala e
2
100.0%
0
0.0%
Lip
3
75.0%
1
25.0%
Re omola igone
0
0.0%
1
100.0%
Tongue
11
78.6%
3
21.4%
T_S age
T2
10
76.9%
3
23.1%
0.02
T3
9
60.0%
6
40.0%
T4a
5
27.8%
13
72.2%
N_S age
0
9
60.0%
6
40.0%
0.042
1
10
83.3%
2
16.7%
2
0
0.0%
1
100.0%
2b
4
33.3%
8
66.7%
2c
1
33.3%
2
66.7%
3b
0
0.0%
3
100.0%
RT Inia ion less han 6 weeks
No
13
40.6%
19
59.4%
0.018
Yes
11
78.6%
3
21.4%
Discussion
O al ca i y squamous cell ca cinoma (OCSCC) emains a signi ican heal h bu den in India, wi h obacco use being a well-
es ablished e iological ac o . In ou s udy, nea ly hal o he pa ien s epo ed smoking and obacco chewing, consis en
wi h na ional pa e ns epo ed in p e ious s udies om India. Smoking demons ably comp omises ou comes in su gical
and adio he apy pa ien s. In su gical con ex s, i heigh ens mo bidi y, while in adio he apy, i exace ba es ea men
oxici ies [8]. Smoking signi ican ly inc eases he isk o pos ope a i e complica ions, cance ecu ence, and mo ali y in
o al ca i y cance pa ien s, and qui ing smoking be o e su ge y can educe hese isks. Cu en smoke s a e a much highe
isk o complica ions such as delayed wound healing, su gical si e in ec ions, pulmona y complica ions (including
pneumonia and ailu e o wean om a en ila o ), and longe hospi al s ays. Me a-analy ic da a show inc eased odds o
nec osis (OR 3.60), wound complica ions (OR 2.27), delayed healing (OR 2.07), and in ec ions (OR 1.79) in smoke s
unde going cance su ge y [9]. Pa ien s who con inue o smoke ha e an 86% highe isk o cance ecu ence and a wo-
old dec ease in 5-yea su i al, compa ed o hose who qui smoking a diagnosis. Ongoing smoking is linked o inc eased
o e all and cance -speci ic mo ali y. These combined e ec s con ibu e o p olonged ea men du a ion and an o e all
poo e p ognosis, unde sco ing smoking's dual ole as a causa i e ac o and a nega i e p ognos ic indica o
D . Mohamed Ib ahim, e al. T ea men package ime in o al ca i y cance pa ien s in egional cance cen e in
Sou h Tamil Nadu-A p ospec i e c oss-sec ional s udy. In . J Med. Pha m. Res., 6 (6): 379-383, 2025
382
The p esen s udy highligh s key clinicopa hological and ea men - ela ed ac o s in luencing he ea men package ime
(TPT)—a su oga e indica o o o e all ea men e iciency and quali y. Al hough he Na ional Cance G id o India and
NCCN guidelines ecommend comple ing de ini i e ea men wi hin 100 days o op imize ea men ou comes, [10] almos
48% o ou pa ien s exceeded his h eshold. Delay in T ea men Package Time ha e been linked wi h in e io loco egional
con ol and o e all su i al in head and neck cance s.
One o he mos c i ical obse a ions in his s udy was he signi ican associa ion be ween adio he apy ini ia ion delay and
p olonged T ea men Package Time. Pa ien s who commenced adju an adio he apy wi hin 6 weeks o su ge y we e
signi ican ly mo e likely o comple e ea men wi hin 100 days (p = 0.018). Only 30% o he s udy popula ion we e able
o ini ia e adio he apy wi hin 6 weeks, es couldn’ due o a ious ac o s which is compa able wi h global da a. This
shows any ac o s like pos op mo bidi y, o he ac o s like inancial, social and emo ional ac o s which delays ea ly
adio he apy ini ia ion, ul ima ely ha e impac on delayed TPT. Insu ance au ho iza ions and ope a ional logis ics wi hin
hospi als delays adio he apy ini ia ion which ul ima ely p olongs he TPT.
Addi ionally, ad anced T-s age (T4a) and highe nodal bu den we e signi ican ly associa ed wi h p olonged TPT. 75% o
ou s udy popula ion p esen ed wi h locally ad anced disease which manda es complex planning and ea men . These
pa ien s o en equi e mo e ex ensi e esec ions and complex econs uc ions, which may lead o longe eco e y pe iods,
delayed wound healing, and consequen ly, de e ed ea ly ini ia ion o adju an he apy and ne e ec o p olonged TPT.
Ou da a esembles da a om o he pa o ou coun y. In e es ingly, lap econs uc ion, al hough expec ed o leng hen
eco e y ime, did no show a s a is ically signi ican impac on TPT in ou coho (p = 0.129). In ac , a majo i y o pa ien s
who ecei ed lap co e age we e s ill able o comple e ea men wi hin 100 days. This sugges s ha wi h s anda dized
pe iope a i e ca e and e icien ehabili a ion p o ocols, econs uc i e su ge y need no be a ba ie o imely adju an
he apy. Tumo si e also signi ican ly in luenced TPT. Tongue cance s had he highes a e o imely ea men comple ion,
possibly due o ea lie symp om ecogni ion and ela i ely s aigh o wa d access o su ge y and su eillance. Con e sely,
umo s o he al eolus, loo o mou h, and e omola igone we e uni o mly associa ed wi h delayed TPT, po en ially
due ad ance disease and need o ex ensi e esec ion and delay in pos ope a i e eco e y.
Counselling he pa ien s abou he signi icance o adju an adio he apy, pa icula ly i s ole in achie ing op imal
loco egional con ol, is essen ial o enhance ea men compliance and acili a e comple ion o he apy wi hin he
ecommended ime ame. Counselling and ehabili a ion o he pa ien should be done be o e ini ia ion o ea men and
con inued du ing he cou se o ea men o accomplish he op imal ou come. This s udy is limi ed by i s small sample size.
Fu he mo e, long- e m oncologic ou comes such as ecu ence- ee su i al and o e all su i al we e no assessed in his
in e im analysis.
Conclusion
This s udy highligh s he mul i ac o ial con ibu o s o ea men delays in o al ca i y squamous cell ca cinoma (OCSCC)
managed wi h su ge y ollowed by adju an adio he apy. Nea ly hal o he pa ien s in ou s udy expe ienced a p olonged
ea men package ime (TPT >100 days), which is known o ad e sely a ec oncologic ou comes. Delayed ini ia ion o
adio he apy beyond six weeks pos -su ge y, ad anced umo size and high nodal bu den, and umo subsi e we e
signi ican ly associa ed wi h p olonged TPT. In con as , a iables such as sex, age and he use o lap econs uc ion did
no show a s a is ically signi ican impac on ea men du a ion. Adhe ing o ecommended ea men imelines should be
p io i ized o op imize disease con ol and o imp o e su i al in OCSCC pa ien s.
Compliance wi h e hical S anda ds
Resea ch in ol ing human pa icipan s: Human pa icipan s we e en olled in o he s udy wi h in o med w i en consen
as pe Ins i u ional E hical Commi ee No ms
Con lic o In e es : None
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