Intensive Chemoradiotherapy as a Primary Treatment for Organ Preservation in Patients With Advanced Cancer of the Head and Neck

Hanna, Ehab Y.; Alexiou, Michael; Morgan, J. E.; Badley, Jenny; Maddox, Anne Marie; Peñagarícano, José; Fan, Chun Yang; Breau, Randall L.; Suen, James Y.

doi:10.1001/archotol.130.7.861

Cited by 73 publications

(47 citation statements)

References 20 publications

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“…To achieve greater rates of disease control and survival coupled with preservation of function, the preferred treatment for advanced HNSCC patients is now CCRT [2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…Organ preservation has been added to the main objective of increasing survival. Since Pignon et al [1] published the results of a meta-analysis showing that concomitant chemoradiation therapy (CCRT) offered a significant improvement in survival in comparison to radiotherapy, protocols based on CCRT have become a gold standard in conservative treatment for locally advanced HNSCC [2][3][4]. One of the consequences of this therapeutic approach is the changing role of surgery for managing these patients [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Esteller

Vega

López

et al. 2010

Eur Arch Otorhinolaryngol

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With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

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“…To achieve greater rates of disease control and survival coupled with preservation of function, the preferred treatment for advanced HNSCC patients is now CCRT [2][3][4].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Esteller

Vega

López

et al. 2010

Eur Arch Otorhinolaryngol

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“…[2][3][4][5][6][7][8][9] This may be due to perceptions that radiation, particularly for T4 bony lesions, is an ineffective modality for advanced OCC. In addition, it is generally thought that radiation doses that would be considered therapeutic for advanced OCC would lead to unacceptable toxicities in the form of xerostomia, or radiation-induced soft-tissue or bone necrosis.…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation for patients with advanced oral cavity cancer

Stenson¹,

Kunnavakkam²,

Cohen³

et al. 2009

The Laryngoscope

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Objectives/Hypothesis:Patients with advanced oral cavity cancer (OCC) typically have not been enrolled in clinical trials utilizing contemporary multimodality strategies. There exist dogmatic expectations of inferior outcome in OCC patients secondary to ineffectiveness of treatment and unacceptable toxicity. The purpose of this study was to analyze survival, swallowing function, and incidence of osteoradionecrosis (ORN) of patients with stage III/IV OCC who have undergone primary concomitant chemoradiotherapy (CRT).Methods:All advanced OCC patients who were enrolled in University of Chicago concomitant CRT protocols from 1994 to 2008 were reviewed. One hundred eleven newly diagnosed advanced OCC patients were evaluated. We performed a subset analysis of 27 additional advanced OCC patients who underwent surgery followed by postoperative CRT. Swallowing function was assessed via oropharyngeal motility study, and a Swallowing Performance Status Scale score was assigned. Presence of clinically significant ORN was documented.Results:Median follow‐up was 3.25 years. Five‐year overall and progression‐free survival was 66.9% and 65.9%, respectively. There was no difference in overall or progression‐free survival when the surgery‐first group was compared with the primary CRT group (P = .88 and P = .86 respectively). Function, without gastric tube requirement, was excellent, with 92.2% of patients able to maintain weight via oral route. Incidence of ORN was 18.4%, occurring in nine of 49 patients evaluated.Conclusions:Our data support the use of primary CRT as a viable treatment option for patients with advanced OCC. Survival is high, and overall function for the majority of patients is satisfactory. Patients with T4 oral tongue cancer may be spared total glossectomy. The incidence of ORN may be considered acceptable, in light of the benefits of enduring life and function. Laryngoscope, 2010

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“…Surgery is usually selected for younger patients with resectable disease while inoperable cases receive definitive chemoradiation [14,15,16,17]. The best therapeutic modality should be tailored to the individual patient through a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%

Impact of Tumor Board Recommendations on Treatment Outcome for Locally Advanced Head and Neck Cancer

Nguyen¹,

Vos

Lee

et al. 2008

Oncology

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Background/Aims: To identify physician selection factors in the treatment of locally advanced head and neck cancer and how treatment outcome is affected by Tumor Board recommendations. Methods: A retrospective analysis of 213 patients treated for locally advanced head and neck cancer in a single institution was performed. All treatments followed Tumor Board recommendations: 115 patients had chemotherapy and radiation, and 98 patients received postoperative radiation. Patient characteristics, treatment toxicity, locoregional control and survival between these two treat- ment groups were compared. Patient survival was compared with survival data reported in randomized studies of locally advanced head and neck cancer. Results: There were no differences in comorbidity factors, and T or N stages between the two groups. A statistically significant number of patients with oropharyngeal and oral cavity tumors had chemoradiation and postoperative radiation, respectively (p < 0.0001). Grade 3–4 toxicities during treatment were 48 and 87% for the postoperative radiation and chemoradiation groups, respectively (p = 0.0001). There were no differences in survival, locoregional recurrences and distant metastases between the two groups. Patient survival was comparable to survival rates reported by randomized studies of locally advanced head and neck cancer. Conclusion: Disease sites remained the key determining factor for treatment selection. Multidisciplinary approaches provided optimal treatment outcome for locally advanced head and neck cancer, with overall survival in these patients being comparable to that reported in randomized clinical trials.

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Intensive Chemoradiotherapy as a Primary Treatment for Organ Preservation in Patients With Advanced Cancer of the Head and Neck

Cited by 73 publications

References 20 publications

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Chemoradiation for patients with advanced oral cavity cancer

Impact of Tumor Board Recommendations on Treatment Outcome for Locally Advanced Head and Neck Cancer

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