Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience

Abstract

This analysis suggests that pattern of failure in primary head and neck cancer may be dependent upon treatment strategy. Randomized clinical trials of induction chemotherapy are warranted as a means to determine if a decrease in distant metastases can lead to an increase in survival rates in the setting of effective chemoradiotherapy for locoregional control. Additionally, this analysis provides impetus for randomized clinical trials of organ preservation chemoradiotherapy in sites outside the larynx and hypopharynx.

The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer

“…[2][3][4] Because current treatment protocols focus primarily on improving locoregional control, further gains in survival may come from improved treatment or the prevention of distant recurrence, second primary cancer, and comorbid medical illnesses. [15][16][17][18] In this article, we demonstrated that with highly effective locoregional therapy delivered by a dedicated multidisciplinary team, head and neck cancer patients now fail mostly at distant disease sites.…”

“…These results are consistent with the experience of other recent reports. 2,[19][20][21] It is clear that PET/CT imaging detects disease recurrence earlier than expectant management.…”

“…1 After radiotherapy (RT), patients remain at significant risk for local, regional, or distant failure and second primary aerodigestive tumors. 2 Although the optimal approach to clinical follow-up remains controversial, there is significant interest in the application of positron emission tomography (PET)/CT to overcome the limitations of physical examination or conventional imaging alone. [3][4][5] On the basis of previously published data suggesting that 18 F-fluorodeoxyglucose (FDG)-PET offers a more accurate assessment of therapy response and earlier detection of recurrent disease than conventional imaging, our group instituted a protocol incorporating PET/CT in the follow-up of patients with head and neck cancers in July, 2005.…”

Randomized scheduling feasibility study of S-1 for adjuvant chemotherapy in advanced head and neck cancer

“…Recently, many studies on locoregionally advanced SCCHN have been focusing on neoadjuvant chemotherapy (NAC) with a high complete response (CR) rate followed by definitive radiotherapy, or concurrent chemoradiotherapy showing to improve the survival rate and to preserve functions and organs (Pignon et al, 2000;Monnerat et al, 2002;Forastiere et al, 2003;Haddad et al, 2003). However, 20 -30% of advanced patients with a pathologically CR even after the recent aggressive treatment has been showing locoregionally recurrent and/or distant metastatic tumours (unpublished data in our institutes) resulting in the poor outcome nevertheless (Argiris et al, 2004;Brockstein et al, 2004;Cohen et al, 2004). Based on these results, more advanced multidisciplinary treatments should be indispensable in the aim of improving the poor outcome of patients with advanced SCCHN.…”

Conformal re-irradiation of recurrent head and neck tumors

“…Показатели выживаемости у них существенно ниже, а прогноз хуже, чем у пациентов с первичными новооб-разованиями. Частота встречаемости рецидивных образо-ваний при плоскоклеточном раке органов головы и шеи колеблется, по данным разных авторов, от 30 до 50% [1,2]. Следует отметить, что терапевтические возможности ле-чения рецидивных злокачественных опухолей существен-но ниже из-за проведенного ранее как самостоятельного лучевого, так и химиолучевого лечения.…”