Cancer Res Treat.  2022 Jan;54(1):109-117. 10.4143/crt.2020.1329.

Induction Chemotherapy as a Prognostication Index and Guidance for Treatment of Locally Advanced Head and Neck Squamous Cell Carcinoma: The Concept of Chemo-Selection (KCSG HN13-01)

• Lee YG
• Kang EJ
• Keam B
• Choi JH
• Kim JS
• Park KU
• Lee KE
• Kim HJ
• Lee KW
• Kim MK
• Ahn HK
• Shin SH
• Kim HR
• Kim SB
• Yun HJ

• KMID: 2524592
• DOI: http://doi.org/10.4143/crt.2020.1329

Abstract

Purpose
Certain patient subgroups who do not respond to induction chemotherapy (IC) show inherent chemoresistance in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This study aimed to assess the prognostic value of IC, and role of IC in guiding the selection of a definitive locoregional therapy.
Materials and Methods
Out of the 445 patients in multi-institutional LA-HNSCC cohort, 158 (36%) receiving IC were enrolled. The study outcome was to assess overall survival (OS) through IC responsiveness and its role to select subsequent treatments.
Results
Among 135 patients who completed subsequent treatment following IC, 74% responded to IC (complete response in 17% and partial response in 58%). IC-non-responders showed 4.5 times higher risk of mortality than IC-responders (hazard ratio, 4.52; 95% confidence interval, 2.32 to 8.81; p < 0.001). Among IC-responders, 84% subsequently received definitive concurrent chemoradiotherapy (CCRT) and OS was not differed by surgery or CCRT (p=0.960). Regarding IC-non-responders, 54% received CCRT and 46% underwent surgery, and OS was poor in CCRT (24-month survival rate of 38%) or surgery (24-month survival rate of 63%).
Conclusion
Response to IC is a favorable prognostic factor. For IC-responders, either surgery or CCRT achieved similar survival probabilities. For IC-non-responder, multidisciplinary approach was warranted reflecting patients’ preference, morbidity, and prognosis.

Keyword

Locally advanced head and neck squamous cell carcinoma; Induction chemotherapy; Subsequent treatment

Figure

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  Fig. 1 Flowchart of study population and treatment schemes according to treatment response depicting response to therapy and treatment disposition. CCRT, concurrent chemoradiotherapy; CR, complete response; ECOG PS, Eastern Cooperative Oncology Group performance status; HNSCC, head and neck squamous cell carcinoma; IC, induction chemotherapy; PD, progressive disease; PR, partial response; RT, radiotherapy; SD, stable disease.

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  Fig. 2 Overall survival according to induction chemotherapy (IC) and subsequent treatments. 24-Month overall survival probabilities in IC responder followed by concurrent chemoradiotherapy (CCRT): 85% (95% CI, 73 to 91). 24-Month overall survival probabilities in IC responder followed by surgery: 88% (95% CI, 59 to 97). 24-Month overall survival probabilities in IC non-responder followed by CCRT: 38% (95% CI, 14 to 62). 24-Month overall survival probabilities in IC non-responder followed by surgery: 63% (95% CI, 32 to 83).

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  Fig. 3 (A) Overall survival according to response to induction chemotherapy (IC). (B) Overall survival according to IC responsiveness. CR, complete response; PD, progressive disease; PR, partial response; SD, stable disease.

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  Fig. 4 Overall survival according to locoregional treatment after induction chemotherapy (IC). Hazard ratio, 1.44; 95% confidence interval, 0.71 to 2.95; p=0.314. CCRT, concurrent chemoradiotherapy.

Reference

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