Cancer Res Treat.  2013 Mar;45(1):31-39.

Adjuvant Postoperative Radiotherapy with or without Chemotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: The Importance of Patient Selection for the Postoperative Chemoradiotherapy

Affiliations
  • 1Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
  • 2Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. yeonkim7@catholic.ac.kr
  • 3Department of Medical Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 4Head and Neck Surgery Center, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

PURPOSE
We wanted to evaluate the role of postoperative chemoradiotherapy (CRT) for patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN).
MATERIALS AND METHODS
From March 1993 to July 2008, 101 patients with advanced SCCHN and who had undergone macroscopically complete resection were enrolled. Survival and the cumulative incidence of local or regional relapse, metastasis, and acute toxicity were analyzed.
RESULTS
There was a marginally significant difference of disease-free survival at five years in favor of the CRT arm (51.3% vs. 41.8%, respectively; p=0.10). However, there was no significant difference in overall survival between the two treatment arms (p=0.20). The rate of locoregional failure only for the radiotherapy arm was significantly higher than that for the CRT arm (23.2% vs. 4.4%, respectively; p=0.01). The incidence of grade 3 or 4 hematologic toxicity was significantly higher in the CRT arm than that in the radiotherapy arm (37.7% vs. 1.7%, respectively; p=0.01). In CRT arm, early mortality group within 1 year had low performance status and old age over sixty compared with those of the others.
CONCLUSION
After curative-intent surgery, adjuvant CRT is more effective in locoregional tumor control than radiotherapy alone for patients with advanced SCCHN. However, compared with radiotherapy alone, this combined modality treatment had no survival benefit, and was significantly associated with increased toxicity. Thus, patients with low performance status and old age must be cautious in selection of toxic trimodality treatment.

Keyword

Chemoradiotherapy; Head and neck neoplasms; Prognosis; Radiotherapy

MeSH Terms

Arm
Carcinoma, Squamous Cell
Chemoradiotherapy
Disease-Free Survival
Head
Head and Neck Neoplasms
Humans
Incidence
Neck
Neoplasm Metastasis
Patient Selection
Prognosis
Recurrence
Carcinoma, Squamous Cell
Head and Neck Neoplasms

Figure

  • Fig. 1 The Kaplan-Meier estimates of disease-free survival (DFS) at five years were 41.8% in the radiotherapy (RT) arm and 51.3% in the chemoradiotherapy (CRT) arm, respectively. There was a marginal difference in DFS in favor of the CRT group.

  • Fig. 2 The Kaplan-Meier estimates of overall survival (OS) at five years were 47.2% in the radiotherapy (RT) group and 63.2% in the combined therapy group, respectively. However, there was no significant difference in OS between two treatment arms. CRT, chemoradiotherapy.


Reference

1. Vikram B, Strong EW, Shah JP, Spiro R. Failure at the primary site following multimodality treatment in advanced head and neck cancer. Head Neck Surg. 1984; 6:720–723. PMID: 6693287.
Article
2. Tupchong L, Scott CB, Blitzer PH, Marcial VA, Lowry LD, Jacobs JR, et al. Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03. Int J Radiat Oncol Biol Phys. 1991; 20:21–28. PMID: 1993628.
Article
3. Laramore GE, Scott CB, al-Sarraf M, Haselow RE, Ervin TJ, Wheeler R, et al. Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: report on Intergroup Study 0034. Int J Radiat Oncol Biol Phys. 1992; 23:705–713. PMID: 1618662.
4. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004; 350:1945–1952. PMID: 15128894.
Article
5. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004; 350:1937–1944. PMID: 15128893.
Article
6. Johnson JT, Barnes EL, Myers EN, Schramm VL Jr, Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol. 1981; 107:725–729. PMID: 7316852.
Article
7. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005; 27:843–850. PMID: 16161069.
8. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31:1341–1346. PMID: 7713792.
Article
9. Singh B, Bhaya M, Zimbler M, Stern J, Roland JT, Rosenfeld RM, et al. Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma. Head Neck. 1998; 20:1–7. PMID: 9464945.
Article
10. Chen AY, Matson LK, Roberts D, Goepfert H. The significance of comorbidity in advanced laryngeal cancer. Head Neck. 2001; 23:566–572. PMID: 11400245.
Article
11. Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol. 2007; 14:1449–1457. PMID: 17235712.
Article
12. Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst. 1999; 91:2081–2086. PMID: 10601378.
Article
13. Adelstein DJ, Lavertu P, Saxton JP, Secic M, Wood BG, Wanamaker JR, et al. Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer. 2000; 88:876–883. PMID: 10679658.
Article
14. Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998; 338:1798–1804. PMID: 9632446.
Article
15. Bachaud JM, Cohen-Jonathan E, Alzieu C, David JM, Serrano E, Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys. 1996; 36:999–1004. PMID: 8985019.
Article
16. Al-Sarraf M, Pajak TF, Marcial VA, Mowry P, Cooper JS, Stetz J, et al. Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer. 1987; 59:259–265. PMID: 3802013.
Article
17. Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M. Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer. 2010; 18:433–437. PMID: 19562384.
Article
18. Marcu L, van Doorn T, Olver I. Modelling of post-irradiation accelerated repopulation in squamous cell carcinomas. Phys Med Biol. 2004; 49:3767–3779. PMID: 15446804.
Article
19. Ahn JS, Cho SH, Kim OK, Lee JK, Yang DH, Kim YK, et al. The efficacy of an induction chemotherapy combination with docetaxel, cisplatin, and 5-FU followed by concurrent chemoradiotherapy in advanced head and neck cancer. Cancer Res Treat. 2007; 39:93–98. PMID: 19746222.
Article
20. Finnegan V, Parsons JT, Greene BD, Sharma V. Neoadjuvant chemotherapy followed by concurrent hyperfractionated radiation therapy and sensitizing chemotherapy for locally advanced (T3-T4) oropharyngeal squamous cell carcinoma. Head Neck. 2009; 31:167–174. PMID: 18853443.
Article
21. Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys. 1993; 26:3–11. PMID: 8482629.
Article
22. Lee JH, Kim SH, Suh YJ, Shim BY, Kim HK. Predictors of axillary lymph node metastases (ALNM) in a Korean population with T1-2 breast carcinoma: triple negative breast cancer has a high incidence of ALNM irrespective of the tumor size. Cancer Res Treat. 2010; 42:30–36. PMID: 20369049.
Article
23. Lee JH, Kim SH, Kim JG, Cho HM, Shim BY. Preoperative chemoradiotherapy (CRT) followed by laparoscopic surgery for rectal cancer: predictors of the tumor response and the long-term oncologic outcomes. Int J Radiat Oncol Biol Phys. 2011; 81:431–438. PMID: 20732756.
Article
24. Lee JH, Kim DY, Nam TK, Yoon SC, Lee DS, Park JW, et al. Long-term follow-up of preoperative pelvic radiation therapy and concomitant boost irradiation in locally advanced rectal cancer patients: a multi-institutional phase II study (KROG 04-01). Int J Radiat Oncol Biol Phys. 2012; 84:955–961. PMID: 22537540.
Article
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