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

• Lee JH
• Song JH
• Lee SN
• Kang JH
• Kim MS
• Sun DI
• Kim YS

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

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  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.

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