Annals of Oncology 15:1179-1186, 2004
© 2004 European Society for Medical Oncology
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
Background: Locoregionally advanced, stage IV head and neck cancer has traditionally carried a poor prognosis. We sought to assess changes in patterns of failure, prognostic factors for recurrence, and overall outcome, using two different strategies of chemoradiotherapy conducted in prospective, multi-institutional phase II trials.Patients and methods: Three hundred and thirty-seven stage IV patients were treated from 1989 to 1998. We compared locoregional and distant recurrence rates, overall survival and progression-free survival from two different treatment strategies: intensive induction chemotherapy followed by split-course chemoradiotherapy (type 1, n=127), or intensified, split-course, hyperfractionated multiagent chemoradiotherapy alone (type 2, n=210). Univariate and multivariate analyses of 12 chosen covariates were assessed separately for the two study types.
Results: The pattern of failure varied greatly between study types 1 and 2 (5-year locoregional failure of 31% and 17% for study types 1 and 2, respectively, P=0.01; 5-year distant failure rate of 13% and 22% for study types 1 and 2, P=0.03). Combined 5-year overall survival was 47% [95% confidence interval (CI) 41% to 53%) and progression-free survival was 60% (95% CI 55% to 66%). Both treatment strategies yielded similar survival rates. Poor overall survival and distant recurrence were best predicted by advanced nodal stage. Locoregional recurrence was extremely rare for patients with T0–T3 tumor stage, regardless of lymph-node stage.
Conclusions: 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.
Departments of 1 Internal Medicine and 2Otolaryngology, Evanston Northwestern Healthcare, Evanston, IL; Departments of 3 Internal Medicine, 4Preventative Medicine, 5Radiation Oncology and 6Otolaryngology, Northwestern University, Feinberg School of Medicine, Chicago, IL and Robert H. Lurie Comprehensive Cancer Center; Departments of 7 Internal Medicine, 8 Radiation Oncology and 9 Otolaryngology, University of Chicago, Chicago, IL and University of Chicago Cancer Research Center; 10 Section of Head and Neck and Thoracic Oncology, M.D. Anderson Cancer Center, Houston, TX; 11 Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL; 12 Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, IL, USA
* Correspondence to: Dr B. Brockstein, Northwestern University, Feinberg School of Medicine, Evanston Northwestern Healthcare, Section of Oncology/Hematology, 2650 Ridge Ave, Evanston, IL 60201, USA. Tel: +1-847-570-2515; Fax: +1-847-570-2336; Email: b-brockstein{at}northwestern.edu
Key words: chemoradiotherapy, head and neck cancer, induction chemotherapy, patterns of failure, prognostic factors
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. S. Kies, F. C. Holsinger, J. J. Lee, W. N. William Jr, B. S. Glisson, H. Y. Lin, J. S. Lewin, L. E. Ginsberg, K. A. Gillaspy, E. Massarelli, et al. Induction Chemotherapy and Cetuximab for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: Results From a Phase II Prospective Trial J. Clin. Oncol., January 1, 2010; 28(1): 8 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Rischin Oropharyngeal Cancer, Human Papilloma Virus, and Clinical Trials J. Clin. Oncol., January 1, 2010; 28(1): 1 - 3. [Full Text] [PDF]
|
|
|
|
|
|
L. K. Mell, J. J. Dignam, J. K. Salama, E. E.W. Cohen, B. N. Polite, V. Dandekar, A. D. Bhate, M. E. Witt, D. J. Haraf, B. B. Mittal, et al. Predictors of Competing Mortality in Advanced Head and Neck Cancer J. Clin. Oncol., January 1, 2010; 28(1): 15 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Posner, C. M. Norris, L. J. Wirth, D. M. Shin, K. J. Cullen, E. W. Winquist, C. R. Blajman, E. A. Mickiewicz, G. P. Frenette, L. F. Plinar, et al. Sequential therapy for the locally advanced larynx and hypopharynx cancer subgroup in TAX 324: survival, surgery, and organ preservation Ann. Onc., May 1, 2009; 20(5): 921 - 927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. N. Cohen, M. S. Veena, E. S. Srivatsan, and M. B. Wang Suppression of Interleukin 6 and 8 Production in Head and Neck Cancer Cells With Curcumin via Inhibition of I{kappa}{beta} Kinase Arch Otolaryngol Head Neck Surg, February 1, 2009; 135(2): 190 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Salama, K. M. Stenson, E. O. Kistner, B. B. Mittal, A. Argiris, M. E. Witt, F. Rosen, B. E. Brockstein, E. E. W. Cohen, D. J. Haraf, et al. Induction chemotherapy and concurrent chemoradiotherapy for locoregionally advanced head and neck cancer: a multi-institutional phase II trial investigating three radiotherapy dose levels Ann. Onc., October 1, 2008; 19(10): 1787 - 1794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. R. Knab, J. K. Salama, A. Solanki, K. M. Stenson, E. E. Cohen, M. E. Witt, D. J. Haraf, and E. E. Vokes Functional organ preservation with definitive chemoradiotherapy for T4 laryngeal squamous cell carcinoma Ann. Onc., September 1, 2008; 19(9): 1650 - 1654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Choong and E. Vokes Expanding Role of the Medical Oncologist in the Management of Head and Neck Cancer CA Cancer J Clin, January 1, 2008; 58(1): 32 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. K. Lee, R. T.P. Poon, J. Y. Wo, S. Ma, X.-Y. Guan, J. N. Myers, P. Altevogt, and A. P.W. Yuen Lupeol Suppresses Cisplatin-Induced Nuclear Factor-{kappa}B Activation in Head and Neck Squamous Cell Carcinoma and Inhibits Local Invasion and Nodal Metastasis in an Orthotopic Nude Mouse Model Cancer Res., September 15, 2007; 67(18): 8800 - 8809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G.C. Troost, W. V. Vogel, M. A.W. Merkx, P. J. Slootweg, H. A.M. Marres, W. J.M. Peeters, J. Bussink, A. J. van der Kogel, W. J.G. Oyen, and J. H.A.M. Kaanders 18F-FLT PET Does Not Discriminate Between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients J. Nucl. Med., May 1, 2007; 48(5): 726 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. E.W. Cohen, D. J. Haraf, M. A. List, M. Kocherginsky, B. B. Mittal, F. Rosen, B. Brockstein, R. Williams, M. E. Witt, K. M. Stenson, et al. High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial J. Clin. Oncol., July 20, 2006; 24(21): 3438 - 3444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Adelstein and M. LeBlanc Does Induction Chemotherapy Have a Role in the Management of Locoregionally Advanced Squamous Cell Head and Neck Cancer? J. Clin. Oncol., June 10, 2006; 24(17): 2624 - 2628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Schoder, D. L. Carlson, D. H. Kraus, H. E. Stambuk, M. Gonen, Y. E. Erdi, H. W.D. Yeung, A. G. Huvos, J. P. Shah, S. M. Larson, et al. 18F-FDG PET/CT for Detecting Nodal Metastases in Patients with Oral Cancer Staged N0 by Clinical Examination and CT/MRI J. Nucl. Med., May 1, 2006; 47(5): 755 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Conley Treatment of Advanced Head and Neck Cancer: What Lessons Have We Learned? J. Clin. Oncol., March 1, 2006; 24(7): 1023 - 1025. [Full Text] [PDF]
|
|
|
|
|
|
D. G. Pfister and J. A. Ridge Induction Chemotherapy for Larynx Preservation: Patient Selection or Therapeutic Effect? J. Clin. Oncol., February 1, 2006; 24(4): 540 - 543. [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. LoTempio, M. S. Veena, H. L. Steele, B. Ramamurthy, T. S. Ramalingam, A. N. Cohen, R. Chakrabarti, E. S. Srivatsan, and M. B. Wang Curcumin Suppresses Growth of Head and Neck Squamous Cell Carcinoma Clin. Cancer Res., October 1, 2005; 11(19): 6994 - 7002. [Abstract] [Full Text] [PDF]
|
|