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Comparison of radiochemotherapy alone to surgery plus radio(chemo)therapy for non-metastatic stage III/IV squamous cell carcinoma of the head and neck

A matched-pair analysis

Vergleich von definitiver Radiochemotherapie und Operation plus Radio(chemo)therapie beim nicht metastasierten Plattenepithelkarzinom der Kopf-Hals-Region im Stadium III/IV – eine Matched-Pair-Analyse

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Abstract

Background and Purpose

The standard treatment for non-metastatic stage III/IV squamous cell carcinoma of the head and neck varies worldwide. This study compared the outcomes of radiochemotherapy alone to surgery followed by radio(chemo)therapy (radiotherapy plus/minus concurrent chemotherapy).

Patients and Methods

Data from 148 patients treated with radiochemotherapy alone were matched to 148 patients treated with surgery plus radio(chemo)therapy. Groups were matched 1:1 for nine potential prognostic factors including age, gender, performance status, tumor site, histologic grade, T category, N category, AJCC stage, and hemoglobin level before radiotherapy, and compared for locoregional control, metastases-free survival, and overall survival.

Results

Locoregional control rates at 1, 2, and 3 years were 81%, 73%, and 67% after surgery plus radio(chemo)therapy and 81%, 74%, and 65% after radiochemotherapy alone (p = 0.89). Metastases-free survival rates were 86%, 80%, and 75% after surgery plus radio(chemotherapy) versus 87%, 80%, and 72% after radiochemotherapy alone (p = 0.57). Overall survival rates were 80%, 64%, and 63% after surgery plus radio(chemo)therapy versus 83%, 68%, and 60% after radiochemotherapy alone (p = 0.96). On multivariate analyses, T category (p < 0.001), N category (p = 0.004), and hemoglobin level prior to radiotherapy (p < 0.001) were associated with locoregional control. Histologic grade (p = 0.045), T category (p < 0.001), N category (p = 0.003), and hemoglobin level prior to radiotherapy (p < 0.001) were associated with metastases-free survival. Histologic grade (p = 0.030), ECOG perfor-mance status (p = 0.033), T category (p = 0.007), N category (p = 0.024) and hemoglobin level before radiotherapy (p < 0.001) were associated with overall survival.

Conclusion

Outcomes of radiochemotherapy alone appeared similar to those of surgery plus radio(chemo)therapy. Randomized trials comparing both treatments for different tumor sites are warranted.

Zusammenfassung

Hintergrund

Die Standardtherapie von nicht metastasierten Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III/IV variiert weltweit. Diese Studie verglich die Behandlungsergebnisse der definitiven Radiochemotherapie mit den Ergebnissen der Operation plus Radiotherapie/Radiochemotherapie.

Patienten und Methoden

Daten von 148 Patienten, die eine definitive Radiochemotherapie erhielten, wurden mit Daten von 148 Patienten, die eine Operation plus Radiotherapie/Radiochemotherapie erhielten, in Form einer Matched-Pair-Analyse vergli-chen. Es mussten die folgenden neun potentiellen Prognosefaktoren (1:1) übereinstimmen: Alter, Geschlecht, Allgemeinzustand, Tumorlokalisation, Grading, T-Kategorie, N-Kategorie, AJCC-Stadium und Hämoglobinwert vor Strahlentherapie. Die Gruppen wurden hinsichtlich lokoregionaler Kontrolle, metastasenfreien Überlebens und Gesamtüberlebens verglichen.

Ergebnisse

Die Raten für die lokoregionale Kontrolle nach 1, 2 und 3 Jahren betrugen 81%, 73% und 67% nach Operation plus Radio(chemo)therapie sowie 81%, 74% und 65% nach definitiver Radiochemotherapie (p = 0,89). Die Raten für das metastasenfreie Überleben betrugen 86%, 80% und 75% nach Operation plus Radio(chemo)therapie sowie 87%, 80% und 72% nach definitiver Radiochemotherapie (p = 0,57). Die Raten für das Gesamtüberleben waren 80%, 64% und 63% nach Operation plus Radio(chemo)therapie sowie 83%, 68% und 60% nach definitiver Radiochemotherapie (p = 0,96). In den Multivarianzanalysen waren T-Kategorie (p < 0,001), N-Kategorie (p = 0,004) und Hämoglobin vor Strahlentherapie (p < 0,001) mit der lokoregionalen Kontrolle assoziiert, Grading (p = 0,045), T-Kategorie (p < 0,001), N-Kategorie (p = 0,003) und Hämoglobin vor Strahlentherapie (p < 0,001) mit dem metastasenfreien Überleben sowie Grading (p = 0,030), Allgemeinzustand (p = 0,033), T-Kategorie (p = 0,007), N-Kategorie (p = 0,024) und Hämoglobin vor Strahlentherapie (p < 0,001) mit dem Gesamtüberleben.

Schlussfolgerung

Die Behandlungsergebnisse nach definitiver Radiochemotherapie waren denen nach Operation plus Radio(chemo)therapie vergleichbar. Die Ergebnisse müssen in randomisierten Studien für die unterschiedlichen Tumorlokalisationen überprüft werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lubeck, Lubeck, Germany

    Dirk Rades MD & Thekla Meyners

  2. Department of Radiation Oncology, University of Sarajevo, Sarajevo, Bosnia-Herzegovina

    Nadja Kazic

  3. Department of Radiation Oncology, University of Hamburg, Hamburg, Germany

    Amira Bajrovic

  4. Department of Radiation Oncology, Saad Specialist Hospital Al Khobar, Al Khobar, Saudi Arabia

    Volker Rudat

  5. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

    Steven E. Schild

  6. Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany

    Dirk Rades MD

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  1. Dirk Rades MD
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  2. Thekla Meyners
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  4. Amira Bajrovic
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  5. Volker Rudat
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Correspondence to Dirk Rades MD.

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Rades, D., Meyners, T., Kazic, N. et al. Comparison of radiochemotherapy alone to surgery plus radio(chemo)therapy for non-metastatic stage III/IV squamous cell carcinoma of the head and neck. Strahlenther Onkol 187, 541–547 (2011). https://doi.org/10.1007/s00066-011-2262-2

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  • DOI: https://doi.org/10.1007/s00066-011-2262-2

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