Analysis of the factors influencing the efficacy of concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma:based on a phase Ⅲ clinical randomized controlled study
Wang Kai1, Qu Yuan1, Yi Junlin1, Chen Xuesong1, Wang Xiaolei2, Liu Shaoyan2, Xu Zhengang2, Zhang Shiping1, Wu Runye1, Zhang Ye1, Li Suyan1, Luo Jingwei1, Xiao Jianping1, Gao Li1, Xu Guozhen1, Li Yexiong1, Huang Xiaodong1
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups. Methods All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96Gy (27.56-76.00Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250mg (100-570mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan-Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup (P=0.009), and there was an increasing trend in patients aged≤55 years and female patients (P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T4(P=0.048), N3(P=0.005), non-IMRT treatment (P=0.001) and hypopharyngeal carcinoma (P=0.004) subgroups, there was an increasing trend in male (P=0.064), high-and moderate-grade squamous cell carcinoma (P=0.076) and non-surgical treatment subgroups (P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years (P=0.017 and 0.039), women (P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma (P=0.006 and 0.022), N3stage (P=0.001 and 0.017), non-surgical treatment (P=0.007 and 0.033) and non-IMRT treatment subgroups (P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma (P=0.022). Conclusion Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N3stage, non-surgical treatment and non-IMRT treatment patients.
Wang Kai,Qu Yuan,Yi Junlin et al. Analysis of the factors influencing the efficacy of concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma:based on a phase Ⅲ clinical randomized controlled study[J]. Chinese Journal of Radiation Oncology, 2021, 30(3): 230-234.
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