Long-term outcome and patterns of failure in patients with advanced head and neck cancer

被引:48
作者
Hauswald, Henrik [1 ]
Simon, Christian [2 ]
Hecht, Simone [1 ]
Debus, Juergen [1 ]
Lindel, Katja [1 ]
机构
[1] Heidelberg Univ, Dept Radiat Oncol, Heidelberg, Germany
[2] Heidelberg Univ, Dept Otorhinolaryngol, D-6900 Heidelberg, Germany
来源
RADIATION ONCOLOGY | 2011年 / 6卷
关键词
HNSCC; head and neck cancer; radiotherapy; radiochemotherapy; irradiation; long-term follow-up; SQUAMOUS-CELL CARCINOMA; PLUS CONCURRENT CISPLATIN; PHASE-II TRIAL; DISTANT METASTASES; ACCELERATED RADIOTHERAPY; PULMONARY METASTASES; CHEMOTHERAPY; ONCOLOGY; CHEMORADIOTHERAPY; OROPHARYNX;
D O I
10.1186/1748-717X-6-70
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To access the long-time outcome and patterns of failure in patients with advanced head and neck squamous cell carcinoma (HNSCC). Methods and materials: Between 1992 and 2005 127 patients (median age 55 years, UICC stage III n = 6, stage IV n = 121) with primarily inoperable, advanced HNSCC were treated with definite platinum-based radiochemotherapy (median dose 66.4 Gy). Analysed end-points were overall survival (OS), disease-free survival (DFS), loco-regional progression-free survival (LPFS), development of distant metastases (DM), prognostic factors and causes of death. Results: The mean follow-up time was 34 months (range, 3-156 months), the 3-, 5- and 10-year OS rates were 39%, 28% and 14%, respectively. The median OS was 23 months. Forty-seven patients achieved a complete remission and 78 patients a partial remission. The median LPFS was 17 months, the 3-, 5- and 10-year LPFS rates were 41%, 33% and 30%, respectively. The LPFS was dependent on the nodal stage (p = 0.029). The median DFS was 11 months (range, 2-156 months), the 3-, 5- and 10-year DFS rates were 30%, 24% and 22%, respectively. Prognostic factors in univariate analyses were alcohol abuse (n = 102, p = 0.015), complete remission (n = 47, p < 0.001), local recurrence (n = 71, p < 0.001), development of DM (n = 45, p < 0.001; median OS 16 months) and borderline significance in nodal stage N2 versus N3 (p = 0.06). Median OS was 26 months with lung metastases (n = 17). Nodal stage was a predictive factor for the development of DM (p = 0.025). Cause of death was most commonly tumor progression. Conclusions: In stage IV HNSCC long-term survival is rare and DM is a significant predictor for mortality. If patients developed DM, lung metastases had the most favourable prognosis, so intensified palliative treatment might be justified in DM limited to the lungs.
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页数:7
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