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Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma:post-hoc analysis of a phase Ⅲ randomized controlled clinical trial
Wang Kai1, Qu Yuan1, Yi Junlin1, Chen Xuesong1, Wang Xiaolei2, Liu Shaoyan2, Xu Zhengang2, ZhangShiping1, 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
AbstractObjective To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Methods From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan-Meier method. ResultsThe median follow-up time was 59 months (7-139 months). All patients were divided into four groups:radiotherapy group (R group,n=84), concurrent chemo-radiotherapy group (R+C group, n=67), preoperative radiotherapy group (R+S group, n=34) and preoperative concurrent chemoradiotherapy group (R+C+S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+C+S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+C Group vs. R group, P=0.081;R+C+S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+C group vs. R+S group, P=0.064;R+C group vs. R+S group, P=0.016). Conclusions Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.
Wang Kai,Qu Yuan,Yi Junlin et al. Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma:post-hoc analysis of a phase Ⅲ randomized controlled clinical trial[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 502-507.
Wang Kai,Qu Yuan,Yi Junlin et al. Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma:post-hoc analysis of a phase Ⅲ randomized controlled clinical trial[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 502-507.
[1] Mandal R,şenbabaoglu Y, Desrichard A, et al. The head and neck cancer immune landscape and its immunotherapeutic implications[J]. JCI Insight, 2016, 1(17):e89829. DOI:10.1172/jci.insight.89829. [2] Glastonbury CM. Head and neck squamous cell cancer:approach to staging and surveillance[M]//Hodler J, Kubik-Huch RA, von Schulthess GK. Diseases of the brain, head and neck, Spine 2020-2023:diagnostic imaging. Cham:Springer, 2020. [3] Lavaf A, Genden EM, Cesaretti JA, et al. Adjuvant radiotherapy improves overall survival for patients with lymph node-positive head and neck squamous cell carcinoma[J]. Cancer, 2008, 112(3):535-543. DOI:10.1002/cncr.23206. [4] Schwam ZG, Husain Z, Judson BL. Refusal of postoperative radiotherapy and its association with survival in head and neck cancer[J]. Radiother Oncol, 2015, 117(2):343-350, 357. DOI:10.1016/j.radonc.2015.10.013. [5] Pignon JP, leMaître A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-HC):an update on 93 randomized trials and 17346 patients[J]. Radiother Oncol, 2009, 92(1):4-14. DOI:10.1016/j.radonc.2009.04.014. [6] NCCN. Guidelines for patients®[DB/OL][2020-04-10].http://www. NCCN.org/patients. [7] Lee A, Givi B, Roden DF, et al. Utilization and survival of postoperative radiation or chemoradiation for pT1-2N1M0 head and neck cancer[J]. Otolaryngol Head Neck Surg, 2018, 158(4):677-684. DOI:10.1177/0194599817746391. [8] Vandenbrouck C, Sancho H, Le Fur R, et al. Results of a randomized clinical trial of preoperative irradiation versus postoperative in treatment of tumors of the hypopharynx[J]. Cancer, 1977, 39(4):1445-1449. DOI:10.1002/1097-0142(197704)39:4<1445::aid-cncr2820390415>3.0.co;2-6. [9] Tupchong L, Scott CB, Blitzer PH, et al. Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma:long-term follow-up of RTOG study 73-03[J]. Int J Radiat Oncol Biol Phys, 1991, 20(1):21-28. DOI:doi:10.1016/0360-3016(91)90133-o. [10] Wennerberg J. Pre versus post-operative radiotherapy of resectable squamous cell carcinoma of the head and neck[J]. Acta Otolaryngol, 1995, 115(4):465-474. DOI:10.3109/00016489509139350. [11] 张宗敏,唐平章,徐震纲,等. 下咽鳞癌不同治疗方案的临床分析[J]. 中华肿瘤杂志, 2005, 27(1):48-51. Zhang ZM, Tang PZ, Xu ZG, et al. Long-term results of different treatment modalities in 464 hypopharyngeal squamous-cell carcinoma patients[J]. Chin J Oncol, 2005, 27(1):48-51. [12] Yi JL, Huang XD, Xu ZG, et al. Phase Ⅲ randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma[J]. Oncotarget, 2017, 8(27):44842-44850. DOI:10.18632/oncotarget.15107. [13] Ghosh-Laskar S, Kalyani N, Gupta T, et al. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck:results of a prospective randomized trial[J]. Head Neck, 2016, 38(2):202-207. DOI:10.1002/hed.23865. [14] Zhang L, Zhao C, Peng PJ, et al. Phase Ⅲ study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma:preliminary results[J]. J Clin Oncol, 2005, 23(33):8461-8468. DOI:10.1200/JCO.2004.00.3863. [15] Zhang L, Zhao C, Ghimire B, et al. The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population:a meta-analysis of the phase Ⅲ randomized trials[J]. BMC Cancer, 2010, 10:558-567. DOI:10.1186/1471-2407-10-558. [16] Adelstein DJ, Lavertu P, Saxton JP, et al. Mature results of a phase Ⅲ randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage Ⅲ and Ⅳ squamous cell carcinoma of the head and neck[J]. Cancer, 2000, 88(4):876-883. DOI:10.1002/(sici)1097-0142(20000215)88:4<876::aid-cncr19>3.0.co;2-y.
2020, Vol. 29 
