Analysis of the Prognostic Factors for Distant Metastasis after Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Head and Neck Cancer
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Purpose The aim of this study is to identify the prognostic factors of distant metastasis (DM) afterinduction chemotherapy (IC) followed by concurrent chemoradiotherapy (CRT) for locoregionallyadvanced head and neck cancer (HNC). Materials and MethodsA total of 321 patients with HNC who underwent IC followed by CRT treated between January2005 and December 2010 were analyzed retrospectively. IC consisted of three courses ofdocetaxel (70 mg/m2) and cisplatin (75 mg/m2) every three weeks, followed by radiotherapyof 66-70 Gy/2 Gy per fraction/5 fractions per week concurrent with weekly cisplatin (40mg/m2). 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 prognosticfactors influencing DM and survival outcome. ResultsThe five-year loco-regional recurrence and DM rates were 23.6% and 18.2%. N stage, overallduration of radiotherapy, lower neck node involvement, and response to IC were significantfactors for DM. With a median follow-up period of 52 months (range, 4 to 83 months), the5-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. ConclusionEven with the addition of IC, the DM rate and survival outcome were poor when metastaticlower neck lymph nodes were present or when patients failed to respond after receiving IC.
Abstract
Purpose The aim of this study is to identify the prognostic factors of distant metastasis (DM) afterinduction chemotherapy (IC) followed by concurrent chemoradiotherapy (CRT) for locoregionallyadvanced head and neck cancer (HNC). Materials and MethodsA total of 321 patients with HNC who underwent IC followed by CRT treated between January2005 and December 2010 were analyzed retrospectively. IC consisted of three courses ofdocetaxel (70 mg/m2) and cisplatin (75 mg/m2) every three weeks, followed by radiotherapyof 66-70 Gy/2 Gy per fraction/5 fractions per week concurrent with weekly cisplatin (40mg/m2). 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 prognosticfactors influencing DM and survival outcome. ResultsThe five-year loco-regional recurrence and DM rates were 23.6% and 18.2%. N stage, overallduration of radiotherapy, lower neck node involvement, and response to IC were significantfactors for DM. With a median follow-up period of 52 months (range, 4 to 83 months), the5-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. ConclusionEven with the addition of IC, the DM rate and survival outcome were poor when metastaticlower neck lymph nodes were present or when patients failed to respond after receiving IC.
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