Long-term neck control rates after complete response to chemoradiation in patients with advanced head and neck cancer Journal Article
| Authors: | Rengan, R.; Pfister, D. G.; Lee, N. Y.; Kraus, D. H.; Shah, J. P.; Shaha, A. R.; Ben Porat, L. S.; Zelefsky, M. J. |
| Article Title: | Long-term neck control rates after complete response to chemoradiation in patients with advanced head and neck cancer |
| Abstract: | Objectives: To examine the long-term neck failure outcome in patients with advanced head and neck cancer treated on larynx/organ preservation protocols at Memorial Sloan-Kettering Cancer Center. Materials and Methods: Two hundred thirteen patients were enrolled from 1983 through 1995 on larynx/organ preservation protocols receiving induction chemotherapy followed by radiotherapy alone or with concomitant chemotherapy. Eighty-six patients with node-positive disease received definitive chemoradiotherapy at Memorial Sloan-Kettering Cancer Center. A median dose of 70 Gy was delivered. The median follow-up of the surviving patients was 9 years. Results: Sixty-five patients with node-positive disease achieved a clinical complete response and were observed after chemoradiation without immediate neck dissection. The crude rate of subsequent neck failure among those patients according to initial nodal classification was: N1 14% (3 of 21), N2: 15% (6 of 40), N3: 0% (0 of 4). The median overall survival of these patients was: N1: 12.2 years; N2: 6.5 years; N3: 0.8 years. Patients who experienced a complete response to induction chemotherapy in the neck had improved overall survival (53% vs. 29%; P = 0.005) and a lower incidence of neck failure (10% vs. 24%; P = 0.14) when compared with those patients who had less than a complete response. Conclusions: Our data suggests that in patients with advanced neck disease who have a clinical complete response in the neck to chemoradiation long-term neck control is 85% or greater without neck dissection. Whether functional imaging or treatment response to induction chemotherapy would provide better discrimination of the 10% to 15% who may experience neck relapse is an important question for future research initiatives. Copyright © 2008 by Lippincott Williams & Wilkins. |
| Keywords: | cancer chemotherapy; treatment outcome; survival rate; treatment failure; major clinical study; overall survival; neck dissection; carcinoma, squamous cell; cisplatin; advanced cancer; antineoplastic agents; cancer radiotherapy; combined modality therapy; drug megadose; follow up; lymph node metastasis; lymph nodes; lymphatic metastasis; neoplasm staging; radiotherapy dosage; head and neck cancer; head and neck neoplasms; drug response; remission induction; brachytherapy; bleomycin; organ preservation; cancer control; chemoradiation |
| Journal Title: | American Journal of Clinical Oncology |
| Volume: | 31 |
| Issue: | 5 |
| ISSN: | 0277-3732 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2008-10-01 |
| Start Page: | 465 |
| End Page: | 469 |
| Language: | English |
| DOI: | 10.1097/COC.0b013e31816a6208 |
| PUBMED: | 18838883 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "CODEN: AJCOD" - "Source: Scopus" |
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