The effect of radiotherapy on survival in newly‐diagnosed metastatic head and neck squamous cell carcinoma(HNSCC)
Huang Zhou, Liu Weixin, Zhao Dan, Xu Xiaolong, Xiao Shaowen, Zheng Baomin, Wang Weihu, Sun Yan
Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
Abstract：Objective To evaluate the survival outcomes of radiotherapy in patients with newly‐diagnosed metastatic head and neck squamous cell carcinoma (HNSCC) based on data from the Surveillance, Epidemiology and End Results(SEER) database. Methods A total of 1226 patients newly‐diagnosed with metastatic HNSCC between 2010 and 2015 were selected from the SEER database. There were 762 patients (62.1%) in the radiotherapy group and 464 patients (37.9%) in the non‐radiotherapy group. Kaplan‐Meier method was used to calculate the cancer‐specific survival (CSS) and overall survival (OS). The effect of radiotherapy on survival was assessed by Cox multivariate regression and Propensity score‐matched analyses (PSM). According to the results of multivariate analysis, the patients were further divided into low‐, intermediate‐ and high‐risk groups, and the effect of radiotherapy on survival was analyzed in different risk groups. Results The median CSS and OS time of the whole group was 11.0 months and 10.0 months, respectively. For patients in the radiotherapy group and non‐radiotherapy group, the median CSS time was 13.0 months and 6.0 months, and the median OS time was 12.0 months and 6.0 months, respectively. Multivariate analysis showed that age (CSS, P=0.045;OS, P=0.002), primary tumor site (CSS, P=0.021;OS, P<0.001), T stage (CSS, P=0.001;OS, P=0.002), N stage (CSS, P=0.002;OS, P<0.001), number of metastatic organs (CSS, P<0.001;OS, P<0.001), surgery (CSS, P<0.001;OS, P<0.001), radiotherapy (CSS, P<0.001;OS, P<0.001), and chemotherapy (CSS, P<0.001;OS, P<0.001)were the independent prognostic factors. After PSM, patients with and without radiotherapy in the low‐,intermediate‐,and high‐risk groups, the 3‐year CSS rates were 62.5% vs 23.5%(P=0.008), 22.4% vs 15.7%(P=0.001)and 10.5% vs 9.6%(P=0.203), respectively; the 3‐year OS were 58.0% vs 20.8%(P=0.002), 19.8% vs 12.7%(P=0.001)and 7.0% vs 6.1%(P=0.166), respectively. Conclusion Radiotherapy significantly improves CSS and OS in the low‐ and intermediate‐risk groups, but patients in the high‐risk group do not benefit from radiotherapy.
Huang Zhou,Liu Weixin,Zhao Dan et al. The effect of radiotherapy on survival in newly‐diagnosed metastatic head and neck squamous cell carcinoma(HNSCC)[J]. Chinese Journal of Radiation Oncology, 2022, 31(8): 685-690.
[1] Marur S, Forastiere AA.Head and neck squamous cell carcinoma: update on epidemiology, diagnosis,treatment[J]. Mayo Clin Proc, 2016,91(3): 386‐396.DOI: 10.1016/j.mayocp.2015.12.017. [2] Rambeau A, Bastit V, Thureau S, et al.Impact of locoregional irradiation in patients with upfront metastatic head and neck squamous cell carcinoma[J]. Oral Oncol, 2019,93:46‐51.DOI: 10.1016/j.oraloncology.2019.04.005. [3] Vermorken JB, Mesia R, Rivera F, et al.Platinum‐based chemotherapy plus cetuximab in head and neck cancer[J]. N Engl J Med, 2008,359(11): 1116‐1127.DOI: 10.1056/NEJMoa 0802656. [4] Burtness B, Harrington KJ, Greil R, et al.Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck(KEYNOTE‐048): a randomised, open‐label, phase 3 study[J]. Lancet, 2019,394(10212): 1915‐1928.DOI: 10.1016/S0140‐6736(19)32591‐7. [5] You R, Liu YP, Huang PY, et al.Efficacy and safety of locoregional radiotherapy with chemotherapy vs chemotherapy alone in de novo metastatic nasopharyngeal carcinoma: a multicenter phase 3 randomized clinical trial[J]. JAMA Oncol, 2020,6(9): 1345‐1352.DOI: 10.1001/jamaoncol.2020.1808. [6] Slotman BJ, van Tinteren H, Praag JO, et al.Use of thoracic radiotherapy for extensive stage small‐cell lung cancer: a phase 3 randomised controlled trial[J]. The Lancet, 2015,385(9962): 36‐42.DOI: 10.1016/s0140‐6736(14)61085‐0 [7] Rusthoven CG, Jones BL, Flaig TW, et al.Improved survival with prostate radiation in addition to androgen deprivation therapy for men with newly diagnosed metastatic prostate cancer[J]. J Clin Oncol, 2016,34(24): 2835‐2842.DOI: 10.1200/JCO.2016.67.4788. [8] Palma DA, Olson R, Harrow S, et al.Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers(SABR‐COMET): a randomised, phase 2,open‐label trial[J]. Lancet, 2019,393(10185): 2051‐2058.DOI: 10.1016/S0140‐6736(18)32487‐5. [9] Kabarriti R, Baliga S, Ohri N, et al.Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma[J]. Head Neck, 2019,41(1): 130‐138.DOI: 10.1002/hed.25476. [10] Tang É, Nguyen TV, Clatot F, et al.Radiation therapy on primary tumour of synchronous metastatic head and neck squamous cell carcinomas[J]. Cancer Radiother, 2020,24(6‐7): 559‐566.DOI: 10.1016/j.canrad.2020.05.004. [11] Khan SA, Zhao F, Goldstein LJ, et al.Early local therapy for the primary site in de novo stage IV breast cancer: results of a randomized clinical trial(EA2108)[J]. J Clin Oncol, 2022,40(9): 978‐987.DOI: 10.1200/JCO.21.02006. [12] Parker CC, James ND, Brawley CD, et al.Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer(STAMPEDE): a randomised controlled phase 3 trial[J]. Lancet, 2018,392(10162): 2353‐2366.DOI: 10.1016/S0140‐6736(18)32486‐3. [13] Zumsteg ZS, Luu M, Yoshida EJ, et al.Combined high‐intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma: an analysis of the National Cancer Data Base[J]. Cancer, 2017,123(23): 4583‐4593.DOI: 10.1002/cncr.30933. [14] Salama JK, Milano MT.Radical irradiation of extracranial oligometastases[J]. J Clin Oncol, 2014,32(26): 2902‐2912.DOI: 10.1200/JCO.2014.55.9567. [15] Iyengar P, Wardak Z, Gerber DE, et al.Consolidative radiotherapy for limited metastatic non‐small‐cell lung cancer: a phase 2 randomized clinical trial[J]. JAMA Oncol, 2018,4(1): e173501.DOI: 10.1001/jamaoncol.2017.3501. [16] Gomez DR, Blumenschein GR, Lee JJ, et al.Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non‐small‐cell lung cancer without progression after first‐line systemic therapy: a multicentre, randomised, controlled, phase 2 study[J]. Lancet Oncol, 2016,17(12): 1672‐1682.DOI: 10.1016/S1470‐2045(16)30532‐0. [17] Theelen W, Chen D, Verma V, et al.Pembrolizumab with or without radiotherapy for metastatic non‐small‐cell lung cancer: a pooled analysis of two randomised trials[J]. Lancet Respir Med, 2021,9(5): 467‐475.DOI: 10.1016/S2213‐2600(20)30391‐X. [18] Bernstein MB, Krishnan S, Hodge JW, et al.Immunotherapy and stereotactic ablative radiotherapy(ISABR): a curative approach?[J]. Nat Rev Clin Oncol, 2016,13(8): 516‐524.DOI: 10.1038/nrclinonc.2016.30.
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