Analysis of the Prognostic Factors for Distant Metastasis after Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Head and Neck Cancer

Abstract

Purpose The aim of this study is to identify the prognostic factors of distant metastasis (DM) after induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CRT) for locoregionally advanced head and neck cancer (HNC). Materials and Methods A total of 321 patients with HNC who underwent IC followed by CRT treated between January 2005 and December 2010 were analyzed retrospectively. IC consisted of three courses of docetaxel (70 mg/m 2 ) and cisplatin (75 mg/m 2 ) every three weeks, followed by radiotherapy of 66-70 Gy/2 Gy per fraction/5 fractions per week concurrent with weekly cisplatin (40 mg/m 2 ). Tumor/nodal stage, primary site, tumor differentiation, lower neck node involvement (level IV, VB, and supraclavicular regions), number of concurrent chemotherapy cycles, overall duration of radiotherapy, and response to IC were assessed as potential prognostic factors influencing DM and survival outcome. Results The five-year loco-regional recurrence and DM rates were 23.6% and 18.2%. N stage, overall duration of radiotherapy, lower neck node involvement, and response to IC were significant factors for DM. With a median follow-up period of 52 months (range, 4 to 83 months), the 5-year progression-free, DM-free, and overall survival rates were 41.2%, 50.7%, and 55.1%, respectively. Lower neck node involvement (p=0.008) and poor response to IC (p < 0.001) showed an association with significantly inferior DM-free survival. Conclusion Even with the addition of IC, the DM rate and survival outcome were poor when metastatic lower neck lymph nodes were present or when patients failed to respond after receiving IC.

Computed tomography-derived radiomic signature of head and neck squamous cell carcinoma (peri)tumoral tissue for the prediction of locoregional recurrence and distant metastasis after concurrent chemo-radiotherapy

“…We find an overlapping clinical parameter, namely node-stage, between these two clinical models. Indeed high node stage is hypothesized to be one of the major risk factors for the development of distant metastasis [21,22]. We also see some discrepancies between the two clinical models.…”

Induction chemotherapy in locally advanced squamous cell carcinoma of the head and neck: role, controversy, and future directions

“…Furthermore, the location of lymph node involvement may suggest which patients stand to gain a longer distant metastasis-free survival, as shown in a retrospective study by Kim et al, who determined that patients with present versus absent lower neck nodal involvement had a significantly lower 5-year distant metastasis-free survival rate (34.3% versus 55.2%, P = 0.008) [ 40 ]. Additionally, the same study determined that patients with hypopharyngeal SCC may be at higher risk of DF than those with laryngeal tumors (the risk for patients with oropharyngeal and oral cavity disease being somewhere in the middle) [ 40 ]. A meta-analysis by Zhang et al [ 41 ] indicated that the ICT approach significantly reduced the DFR in patients with unresectable disease.…”

Higher positive lymph node ratio indicates poorer distant metastasis–free survival in adenoid cystic carcinoma patients with nodal involvement

“…However, the results showed that the locations of LN invasion had no statistical relationship with either DM or OS rate. In a study of head neck cancer, lower-neck node involvement and poor response to induction chemotherapy were strongly associated with DM-free survival (Kim et al, 2015). ACC cells in LN may extend to the membrane structure with a result of adjacent soft tissue involvement.…”