title: Chemoradiation for metastatic SCCA: role of comorbidity.
abstract: OBJECTIVE
  A previous study of 371 patients with extracapsular spread (ECS) of cervical metastases from squamous cell carcinoma (SCCA) of the head and neck revealed a survival advantage for patients treated with adjuvant chemoradiation, compared with those treated with surgery and radiation or surgery alone. While all patients in the study were offered adjuvant chemotherapy, only 35% selected this option. Comorbidity was identified as a reason for declining chemotherapy. Recently, Piccirillo demonstrated that the Modified Medical Comorbidity Index (MMCI) is a valid instrument to classify and quantify severity of comorbidity. We applied this instrument to previously reported patients with ECS to determine 1) how comorbidity affected treatment selection, 2) whether the survival advantage of adjuvant chemoradiation persisted after controlling for comorbidity, and 3) the impact of comorbidity on outcome.
  
  
  METHODS
  This was a nonrandomized, retrospective study.
  
  
  METHODS
  Patients in the initial study underwent resection of the primary tumor and neck dissection. Eligible patients elected to receive chemoradiation, radiation, or no further treatment. Comorbidity scores were assigned according to the MMCI. Data were analyzed according to disease-specific survival and overall survival.
  
  
  RESULTS
  The study population consisted of 330 patients. More severe comorbidity was related to higher overall mortality rates after controlling for treatment. Adjuvant chemoradiation resulted in improved disease-specific and overall survival compared with adjuvant radiation after adjusting for severity of comorbidity.
  
  
  CONCLUSIONS
  These results substantiate the benefits of adjuvant chemoradiation for patients with SCCA of the head and neck. Furthermore, these results reinforce the importance of comorbidity as a prognostic indicator for this population of patients.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: B
authors.initials: B
authors.lastname: Hathaway
authors.forename: J T
authors.initials: JT
authors.lastname: Johnson
authors.forename: J F
authors.initials: JF
authors.lastname: Piccirillo
authors.forename: C H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: R L
authors.initials: RL
authors.lastname: Wagner
authors.forename: S
authors.initials: S
authors.lastname: Labriola
authors.forename: E N
authors.initials: EN
authors.lastname: Myers
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy*; D015897:Comorbidity; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D002955:Leucovorin; D005472:Fluorouracil; D008727:Methotrexate