title: Impact of race on outcome after definitive radiotherapy for squamous cell carcinoma of the head and neck.
abstract: BACKGROUND
  The objective of the current study was to evaluate the impact of race (black vs. white) on the outcome of patients with invasive squamous cell carcinoma of the head and neck.
  
  
  METHODS
  Between 1983 and 1997, 686 patients completed definitive, twice-daily radiotherapy (RT) alone or combined with a planned neck dissection; no patients received adjuvant chemotherapy. The minimum follow-up was 2 years, and median follow-up was 7 years for living patients. No patients were lost to follow-up. Fifty-five patients were black (8%).
  
  
  RESULTS
  Although the two groups had similar 5-year local-regional control rates (black patients vs. white patients: 70% vs. 76%, respectively; P = 0.275), black patients had double the risk for distant recurrence compared with white patients (27% vs. 13%; P = 0.012). The 5-year cause-specific and absolute survival rates were lower for black patients (52% vs. 74% [P = 0.001] and 29% vs. 52% [P < 0.001], respectively). Multivariate analyses revealed that race was an independent predictor of freedom from distant metastasis (P = 0.013), cause-specific survival (P = 0.005), and absolute survival (P < 0.001).
  
  
  CONCLUSIONS
  Although equal local-regional control rates can be achieved in black patients and white patients with squamous cell carcinoma of the head and neck, the risk of distant recurrence was significantly higher in black patients and resulted in decreased survival. Reevaluation of current strategies for pretreatment metastatic work-ups and development of more effective systemic therapy will be key to improving the survival disparity in this group.
authors.affiliation: Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA.
authors.forename: Majid O F
authors.initials: MO
authors.lastname: Al-Othman
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Henrietta L
authors.initials: HL
authors.lastname: Logan
authors.forename: Russell W
authors.initials: RW
authors.lastname: Hinerman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D044465:White People