Definitive chemoradiotherapy in patients with squamous cell cancers of the head and neck - results from an unselected cohort of the clinical cooperation group “Personalized Radiotherapy in Head and Neck Cancer”

Abstract

BackgroundDefinitive chemoradiotherapy (dCRT) is a standard treatment for patients with locally advanced head and neck cancer. There is a clinical need for a stratification of this prognostically heterogeneous group of tumors in order to optimize treatment of individual patients. We retrospectively reviewed all patients with head and neck squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, hypopharynx, or larynx, treated with dCRT from 09/2008 until 03/2016 at the Department of Radiation Oncology, LMU Munich. Here we report the clinical results of the cohort which represent the basis for biomarker discovery and molecular genetic research within the framework of a clinical cooperation group.MethodsPatient data were collected and analyzed for outcome and treatment failures with regard to previously described and established risk factors.ResultsWe identified 184 patients with a median follow-up of 65 months and a median age of 64 years. Patients received dCRT with a median dose of 70 Gy and simultaneous chemotherapy in 90.2% of cases, mostly mitomycin C / 5-FU in concordance with the ARO 95–06 trial. The actuarial 3-year overall survival (OS), local, locoregional and distant failure rates were 42.7, 29.8, 34.0 and 23.4%, respectively. Human papillomavirus-associated oropharynx cancer (HPVOPC) and smaller gross tumor volume were associated with significantly improved locoregional tumor control rate, disease-free survival (DFS) and OS in multivariate analysis. Additionally, lower hemoglobin levels were significantly associated with impaired DFS und OS in univariate analysis. The extent of lymph node involvement was associated with distant failure, DFS and OS. Moreover, 92 patients (50%) of our cohort have been treated in concordance with the ARO 95–06 study, corroborating the results of this study.ConclusionOur cohort is a large unselected monocentric cohort of HNSCC patients treated with dCRT. Tumor control rates and survival rates compare favorably with the results of previously published reports. The clinical data, together with the available tumor samples from biopsies, will allow translational research based on molecular genetic analyses.

Functional Larynx Preservation in Patients With Locally Advanced Squamous Cell Carcinoma of the Larynx and Hypopharynx Treated With Induction Chemotherapy vs. Concurrent Chemoradiation Alone

“…Other studies have also found no link between T stage and local recurrence rate, finding instead that primary tumor volume may be a better predictive tool [ 15 - 18 ]. Our study showed a strong correlation between advanced nodal status (N2-3) and outcomes, which has been corroborated by a number of studies finding links between nodal stage and volume with survival and control outcomes [ 15 , 18 , 19 ]. Finally, there is additional data supporting the use of PET imaging, including metabolic tumor volume and maximum SUV, as a predictor for larynx preservation and OS [ 20 , 21 ].…”

The Epithelial-Mesenchymal Transcription Factor Slug Predicts Survival Benefit of Up-Front Surgery in Head and Neck Cancer

“…In regions associated with a high risk of existing or postoperatively remaining tumor cells, the dose was 60 to a maximum of 66 Gy, and in areas of physiological anatomical lymphatic drainage, the dose was about 50 Gy. For postoperative patients with high-risk features and for patients with advanced disease who received primary RT, concomitant systemic therapy (CRT) was applied [ 30 , 32 , 33 ].…”

Patterns, Predictors, and Prognostic Value of Skeletal Muscle Mass Loss in Patients with Locally Advanced Head and Neck Cancer Undergoing Cisplatin-Based Chemoradiotherapy

“…Although the addition of the cytotoxic compound cisplatin to radiotherapy (RT) improved 5-year PFS from 36% to 47% and 5-year overall survival (OS) from 40% to 53%, it also caused a significant increase in severe functional mucosal adverse effects from 21% to 40% [2]. Due to the increased risk of side-effects, full compliance of chemoradiotherapy (CRT) is seen in only about two-thirds of the initially eligible patients [3][4][5]. Ongoing research evaluates and compares different systemic treatment regimens and novel therapeutic approaches with consideration of potential patient-related (i.e., HPV status) and treatment-related factors (i.e., dose regimen) in order to improve treatment tolerance and survival in LA-HNC patients.…”