Competing causes of death and second primary tumors in patients with locoregionally advanced head and neck cancer treated with chemoradiotherapy
Competing causes of death and second primary tumors in patients with locoregionally advanced head and neck cancer treated with chemoradiotherapy
复制标题
DOI：
10.1158/1078-0432.ccr-03-1077
复制
发表时间：
2004-03-15
影响因子：
11.5
通讯作者：
Vokes, EE
中科院分区：
文献类型：
--
作者：
Argiris, A;Brockstein, BE;Vokes, EE
目的：这项回顾性分析的目的是评估第二原发恶性肿瘤的出现以及不同死因对接受初级放化疗的局部晚期头颈部癌症患者预后的影响。实验设计：我们研究了324名接受同期放化疗的连续5个多中心II期研究的IV期鳞状细胞头颈部癌患者。所有方案均同时应用5-氟尿嘧啶和羟基脲，每隔一周与放射治疗(FHX)或顺铂(C-FHX)或紫杉醇(T-FHX)联合应用。结果：存活患者的中位随访期为5.2年(2-10.6年)。队列的5年总生存率和无进展生存率分别为46%和65%。死亡原因和中位发生时间如下：疾病(n=88；1.5年)，治疗相关急性或晚期并发症(n=30，4个月)，第二原发瘤(n=18，3.5年)，合并症(n=41，1.9年)，不明原因(n=20，5.1年)。死于合并症的主要原因是心脏和呼吸道疾病。26名患者(8%)在中位时间2.8年(4个月至10年)发生第二次原发肿瘤。第二原发癌的累积发生率在3年、5年和10年分别为5%、7%和13%。第二原发灶最常见的部位是肺(n=13)，其次是食道(n=3)和头颈部(n=2)。结论：同期放化疗治疗的局部晚期头颈癌患者可能是可以治愈的，但面临着除疾病进展以外的其他原因的死亡风险。减轻毒性，实施二次筛查和化学预防策略是头颈癌治疗的主要目标。
Purpose: The purpose of this retrospective analysis was to evaluate the emergence of second primary malignancies and the contribution of different causes of death to the outcome of patients with locoregionally advanced head and cancer receiving primary chemoradiotherapy.Experimental Design: We studied 324 patients with stage IV squamous cell head and neck cancer who were enrolled on five consecutive multicenter Phase II studies of concurrent chemoradiotherapy. All of the regimens included concurrent 5-fluorouracil and hydroxyurea on an alternate week schedule with radiotherapy, either alone (FHX) or with cisplatin (C-FHX) or paclitaxel (T-FHX). The cumulative incidence of second primary tumors or death from any cause was estimated using methods of competing risk analysis.Results: Median follow-up of surviving patients was 5.2 years (2-10.6 years). The 5-year overall survival and progression-free survival of the cohort were 46% and 65%, respectively. Causes of death and median time of occurrence were as follows: disease (n = 88; 1.5 years), treatment-associated acute or late complications (n = 30; 4 months), second primary tumors (n = 18; 3.5 years), comorbidities (n = 41; 1.9 years), and unknown (n = 20; 5.1 years). Predominant causes of death from comorbidities were cardiac and respiratory illnesses. Twenty-six patients (8%) developed a second primary tumor at a median time of 2.8 years (4 months to 10 years). The cumulative incidence of second primary tumors was 5%, 7%, and 13% at 3, 5, and 10 years, respectively. The most frequent site of second primaries was the lung (n = 13), followed by the esophagus (n = 3) and head and neck (n = 2)Conclusions: Patients with locoregionally advanced head and neck cancer treated with concurrent chemoradiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression. Ameliorating toxicity, and implementing secondary screening and chemoprevention strategies are major goals in the management of head and neck cancer.