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. 2020 Jan 6;15(1):7.
doi: 10.1186/s13014-019-1452-4.

Definitive chemoradiotherapy in patients with squamous cell cancers of the head and neck - results from an unselected cohort of the clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer"

Lars Schüttrumpf  1   2 , Sebastian Marschner  3   4 , Katrin Scheu  3   5 , Julia Hess  3   5 , Sibylle Rietzler  3   6 , Axel Walch  7 , Philipp Baumeister  3   8 , Thomas Kirchner  3   6 , Ute Ganswindt  3   9 , Horst Zitzelsberger  3   5 , Claus Belka  3   4 , Cornelius Maihoefer  3   4
Affiliations

Definitive chemoradiotherapy in patients with squamous cell cancers of the head and neck - results from an unselected cohort of the clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer"

Lars Schüttrumpf et al. Radiat Oncol. .

Abstract

Background: Definitive chemoradiotherapy (dCRT) is a standard treatment for patients with locally advanced head and neck cancer. There is a clinical need for a stratification of this prognostically heterogeneous group of tumors in order to optimize treatment of individual patients. We retrospectively reviewed all patients with head and neck squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, hypopharynx, or larynx, treated with dCRT from 09/2008 until 03/2016 at the Department of Radiation Oncology, LMU Munich. Here we report the clinical results of the cohort which represent the basis for biomarker discovery and molecular genetic research within the framework of a clinical cooperation group.

Methods: Patient data were collected and analyzed for outcome and treatment failures with regard to previously described and established risk factors.

Results: We identified 184 patients with a median follow-up of 65 months and a median age of 64 years. Patients received dCRT with a median dose of 70 Gy and simultaneous chemotherapy in 90.2% of cases, mostly mitomycin C / 5-FU in concordance with the ARO 95-06 trial. The actuarial 3-year overall survival (OS), local, locoregional and distant failure rates were 42.7, 29.8, 34.0 and 23.4%, respectively. Human papillomavirus-associated oropharynx cancer (HPVOPC) and smaller gross tumor volume were associated with significantly improved locoregional tumor control rate, disease-free survival (DFS) and OS in multivariate analysis. Additionally, lower hemoglobin levels were significantly associated with impaired DFS und OS in univariate analysis. The extent of lymph node involvement was associated with distant failure, DFS and OS. Moreover, 92 patients (50%) of our cohort have been treated in concordance with the ARO 95-06 study, corroborating the results of this study.

Conclusion: Our cohort is a large unselected monocentric cohort of HNSCC patients treated with dCRT. Tumor control rates and survival rates compare favorably with the results of previously published reports. The clinical data, together with the available tumor samples from biopsies, will allow translational research based on molecular genetic analyses.

Keywords: Chemoradiation; Defintive; HNSCC; HPV; Head and neck cancer; Primary; Radiotherapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier plots a overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) of all patients b local, locoregional, distant and any failure rates of all patients. c overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) of the ARO-analogue subgroup d local, locoregional, distant and any failure rates of the ARO-analogue subgroup. Follow-up time was clipped at 60 months. Patients at risk are displayed under the respective plots. Censors are represented by crosses
Fig. 2
Fig. 2
Exemplary Kaplan-Meier plots for clinical risk factors. a local recurrence and primary tumor size (T1–2 vs T3–4) b distant metastasis, c disease free survival, d overall survival and lymph node status (N0-N2a vs N2b-N2c vs N3). P-values (log rank) of the Kaplan-Meier estimates are shown. Follow-up time was clipped at 60 months. Patients at risk are displayed under the respective plots. Censors are represented by crosses
Fig. 3
Fig. 3
Kaplan-Meier plots for patients with HPV-p16-positive oropharyngeal cancer (HPVOPC) vs all other patients (non HPVOPC). a locoregional recurrence b distant recurrence c any recurrence d overall survival (OS) and e disease free survival f disease-specific survival (DSS). P-Values (log rank) of the Kaplan-Meier estimates are shown. Follow-up time was clipped at 60 months. Patients at risk are displayed under the respective plots. Censors are represented by crosses
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