Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience
Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience
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DOI：
10.1093/annonc/mdh308
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发表时间：
2004-08-01
影响因子：
50.5
通讯作者：
Vokes, EE
中科院分区：
文献类型：
--
作者：
Brockstein, B;Haraf, DJ;Vokes, EE
背景：局部晚期，IV期头颈癌传统上预后较差。我们在前瞻性、多机构II期试验中使用两种不同的放化疗策略，试图评估失败模式、复发预后因素和总体结果的变化。患者与方法：1989 ~ 1998年共治疗337例IV期患者。我们比较了两种不同治疗策略的局部和远处复发率、总生存期和无进展生存期：强化诱导化疗后分疗程放化疗（1型，n = 127），或强化、分疗程、超分割多药放化疗（2型，n = 210）。对12个选定的协变量分别进行单因素和多因素分析。结果：研究类型1和研究类型2的失败模式差异很大（研究类型1和研究类型2的5年局部失败率分别为31%和17%，P = 0.01；研究类型1和研究类型2的5年远处失败率分别为13%和22%，P = 0.03）。联合5年总生存率为47%[95%置信区间（CI） 41%至53%]，无进展生存率为60% （95% CI 55%至66%）。两种治疗策略的生存率相似。较差的总生存率和远处复发的最佳预测是晚期淋巴结。无论淋巴结分期如何，T0-T3期肿瘤患者的局部复发极为罕见。结论：本分析提示原发性头颈癌的失败模式可能取决于治疗策略。诱导化疗的随机临床试验有必要作为一种手段，以确定是否远处转移的减少可以导致在有效的局部区域控制放化疗的情况下生存率的增加。此外，该分析为喉和下咽以外部位器官保存放化疗的随机临床试验提供了动力。
Background: Locoregionally advanced, stage IV head and neck cancer has traditionally carried a poor prognosis. We sought to assess changes in patterns of failure, prognostic factors for recurrence, and overall outcome, using two different strategies of chemoradiotherapy conducted in prospective, multi-institutional phase II trials.Patients and methods: Three hundred and thirty-seven stage IV patients were treated from 1989 to 1998. We compared locoregional and distant recurrence rates, overall survival and progression-free survival from two different treatment strategies: intensive induction chemotherapy followed by split-course chemoradiotherapy (type 1, n = 127), or intensified, split-course, hyperfractionated multiagent chemoradiotherapy alone (type 2, n = 210). Univariate and multivariate analyses of 12 chosen covariates were assessed separately for the two study types.Results: The pattern of failure varied greatly between study types 1 and 2 (5-year locoregional failure of 31% and 17% for study types 1 and 2, respectively, P = 0.01; 5-year distant failure rate of 13% and 22% for study types 1 and 2, P = 0.03). Combined 5-year overall survival was 47% [95% confidence interval (CI) 41% to 53%) and progression-free survival was 60% (95% CI 55% to 66%). Both treatment strategies yielded similar survival rates. Poor overall survival and distant recurrence were best predicted by advanced nodal stage. Locoregional recurrence was extremely rare for patients with T0-T3 tumor stage, regardless of lymph-node stage.Conclusions: This analysis suggests that pattern of failure in primary head and neck cancer may be dependent upon treatment strategy. Randomized clinical trials of induction chemotherapy are warranted as a means to determine if a decrease in distant metastases can lead to an increase in survival rates in the setting of effective chemoradiotherapy for locoregional control. Additionally, this analysis provides impetus for randomized clinical trials of organ preservation chemoradiotherapy in sites outside the larynx and hypopharynx.