{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:47:02Z","timestamp":1792126022873,"version":"4.4.0"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100023000","name":"Yenepoya University","doi-asserted-by":"publisher","award":["YU\/Seed grant\/146-2023"],"award-info":[{"award-number":["YU\/Seed grant\/146-2023"]}],"id":[{"id":"10.13039\/100023000","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cancer Control"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Oral squamous cell carcinoma (OSCC) represents a disproportionate cancer burden in South Asia, where advanced-stage presentation, limited radiotherapy infrastructure, and constrained chemotherapy resources necessitate pragmatic approaches to treatment selection. Platinum-based combinations remain the standard for induction chemotherapy; however, a substantial proportion of OSCC patients present with malnutrition, poor performance status, and limited financial resources that preclude these regimens. This is a hypothesis generating feasibility study which explores whether early response to single-agent low-dose methotrexate (MTX) can serve as a functional assay of tumour biology, predicting subsequent radiotherapy response in patients ineligible for conventional multi-agent induction chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective, observational feasibility study was conducted at a comprehensive cancer centre in South India. Treatment-na\u00efve patients (n=30) with histologically confirmed stage III-IV OSCC underwent three weekly intramuscular MTX cycles (20 mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      BSA); tumour response was evaluated by serial imaging and clinical assessment before and after MTX, and post-radiotherapy. Baseline demographics and clinical features were collected. Exploratory analysis using Youden\u2019s J index identified tumour size reduction thresholds associated with radiotherapy response.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MTX administration was well tolerated with no severe toxicities observed in any participants during chemotherapy. Statistically significant reductions in tumour size occurred following MTX (mean = 0.90 cm, p &lt; 0.001), with further reduction after definitive radiotherapy (mean = 3.50 cm, p &lt; 0.001). An exploratory optimal cutoff of 21% tumour size reduction identified patients unlikely to achieve complete radiotherapy response (specificity 94.12%, sensitivity 46.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This feasibility study demonstrates proof-of-concept that early tumour response to low-cost, single-agent MTX correlates with subsequent radiotherapy outcomes in advanced OSCC patients. The strategy offers potential as a triage tool in South Asian resource-constrained settings, but the exploratory 21% cutoff requires external validation in independent cohorts before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748261491729","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:24:56Z","timestamp":1791959096000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-Cost Methotrexate Chemoselection to Predict Radiotherapy Response in Advanced Oral Squamous Cell Carcinoma: A Prospective Feasibility Study From South India"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-7844","authenticated-orcid":false,"given":"Anu","family":"Babu","sequence":"first","affiliation":[{"name":"Yenepoya (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Shetty","sequence":"additional","affiliation":[{"name":"Yenepoya (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achuth S.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Yenepoya (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan Thomas","family":"Mathew","sequence":"additional","affiliation":[{"name":"Yenepoya (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Vijayakumar","sequence":"additional","affiliation":[{"name":"Yenepoya (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26952"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjonc-2024-000466"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2021.1841"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29298"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01235"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70279-5"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.18.00200"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2022.ed122"},{"issue":"2","key":"e_1_3_6_10_2","first-page":"S20","article-title":"Weekly chemotherapy as induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy","volume":"51","author":"Patil VM","year":"2014","unstructured":"Patil VM, Noronha V, Joshi A, et al. Weekly chemotherapy as induction chemotherapy in locally advanced head and neck cancer for patients ineligible for 3 weekly maximum tolerable dose chemotherapy. Indian J Cancer. 2014;51(Suppl 2):S20-S21.","journal-title":"Indian J Cancer"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10565-024-09652-7"},{"issue":"6","key":"e_1_3_6_12_2","first-page":"535","article-title":"Integration of safe initial combination chemotherapy (without cisplatin) with a high response rate and local therapy for untreated stage III and IV epidermoid cancer of the head and neck: 5-year survival data","volume":"67","author":"Price LA","year":"1983","unstructured":"Price LA, MacRae K, Hill BT. Integration of safe initial combination chemotherapy (without cisplatin) with a high response rate and local therapy for untreated stage III and IV epidermoid cancer of the head and neck: 5-year survival data. Cancer Treat Rep. 1983;67(6):535-539.","journal-title":"Cancer Treat Rep"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19840901)54:5<811::AID-CNCR2820540512>3.0.CO;2-C"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199106133242403"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-509X.117024"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13193-019-00951-9"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1741531"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-509X.39376"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2008.10.026"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/mog2.94"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.4103\/jiaomr.jiaomr_145_23"},{"issue":"1","key":"e_1_3_6_23_2","first-page":"8","article-title":"NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2024","volume":"22","author":"Haddad RI","year":"2024","unstructured":"Haddad RI, Beitler JJ, Chau NG, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2024. J Natl Compr Canc Netw. 2024;22(1):8-32.","journal-title":"J Natl Compr Canc Netw"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2008.05.014"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071028"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1002812"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/259154"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604444"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.4103\/2278-0513.158538"}],"container-title":["Cancer Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261491729","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10732748261491729","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261491729","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:16:17Z","timestamp":1792124177000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10732748261491729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":28,"alternative-id":["10.1177\/10732748261491729"],"URL":"https:\/\/doi.org\/10.1177\/10732748261491729","relation":{},"ISSN":["1073-2748","1526-2359"],"issn-type":[{"value":"1073-2748","type":"print"},{"value":"1526-2359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"10732748261491729"}}