Pretreatment prognostic factors influencing distant metastasis-free survival in locally advanced squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy.
OBJECTIVE
To investigate impact of various pretreatment prognostic factors influencing distant metastasis-free survival (DMFS), in patients with locally advanced (stage III/IV), nonmetastatic squamous cell carcinoma of the head and neck.


METHODS
During 2 consecutive prospective randomized trials, a total of 289 patients were treated with standard fraction (conventionally fractionated [CF]) or hyperfractionated radiation therapy with or without concurrent low-dose daily platinum chemotherapy (CHT).


RESULTS
: Kaplan-Meier analysis showed that gender (P = 0.96) and age (P = 0.88) did not influence DMFS, similarly to Karnofsky Performance Status (KPS) (P = 0.55), T stage (P = 0.12), and primary tumor location (P = 0.94). N stage (P = 0.0274), stage grouping (P = 0.0016), treatment (P = 0.0008), and concurrent CHT (P = 0.0001) influenced DMFS. Univariate Cox analysis showed that treatment lost its significance, whereas N staging became marginally insignificant (P = 0.061). Multivariate Cox analysis showed that only lower stage grouping (P = 0.014) and the addition of concurrent CHT (P < 0.001) were independent prognosticator of improved DMFS.


CONCLUSIONS
This analysis showed that only stage grouping and concurrent CHT predicted DMFS in patients with locally advanced squamous cell carcinoma of the head and neck treated with RT with and without concurrent low-dose daily CHT. These results may have implication for future studies in this disease.
Jeremić
Branislav
B
Department of Oncology, University Hospital, Kragujevac, Serbia. b.jeremic@iaea.org
Miličić
Biljana
B
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin