Definitive chemoirradiation for resectable head and neck cancer: Treatment outcome and prognostic significance of MRI findings
Journal
British Journal of Radiology
Journal Volume
81
Journal Issue
966
Pages
490-498
Date Issued
2008
Author(s)
Abstract
The aim of this study was to evaluate the outcome and prognosticators for patients with resectable head and neck cancer (RHNC) undergoing definitive concurrent chemotherapy and radiotherapy (CCRT). In total, 110 RHNC patients receiving definitive CCRT to defer radical surgery were enrolled. Radiotherapy was given as either 2 Gy once daily with 70 Gy, or 1.2 Gy twice daily with 74.4 Gy. Chemotherapy involved the administration of 5-fluorouracil and cisplatin in two concomitant and two post-radiotherapy adjuvant cycles. 3 months after CCRT, MRI was performed to evaluate the response and determine further treatment plans. Survival outcome was calculated by the Kaplan-Meier method. Log-rank test and Cox regression analyses were used to estimate the significance of prognosticators. 4-year local-regional control, distant metastasis-free survival, disease-free survival and overall survival rates were 76.1%, 85.6%, 67.5% and 53.2%, respectively. Local recurrence (odds ratio = 4.09; p<0.0001) and T3/T4 stage (odds ratio = 2.34; p=0.01) were the independent factors associated with poor survival. T stage (odds ratio = 3.29; p=0.03) and/or remission status on post-CCRT MRI (odds ratio = 7.22; p<0.0001) were significantly associated with local control, distant metastasis-free survival and disease-free survival. 13 of 20 patients with imaging residuum had local recurrence, compared with 12 of 89 with complete remission (4-year local control rate of 27% vs 86%; p<0.0001). Post-CCRT MRI may thus be used to predict the chance of a successful non-surgical approach. ? 2008 The British Institute of Radiology.
Other Subjects
cisplatin; fluorouracil; adult; aged; anemia; article; cancer chemotherapy; cancer radiotherapy; cancer surgery; controlled study; disease free survival; female; head and neck cancer; human; infection; Kaplan Meier method; leukopenia; log rank test; major clinical study; male; metastasis; mucosa inflammation; multiple cycle treatment; nausea and vomiting; nuclear magnetic resonance imaging; outcome assessment; overall survival; prognosis; radiation dose; regression analysis; risk; side effect; thrombocytopenia; weight reduction; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Female; Fluorouracil; Head and Neck Neoplasms; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prognosis; Radiotherapy, Adjuvant; Retrospective Studies
Type
journal article