title: High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer.
abstract: OBJECTIVE
  To test for a possible correlation between high-grade acute organ toxicity during primary radio(chemo)therapy and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  From 05/1994 to 01/2009, 216 HNSCC patients were treated with radio(chemo)therapy in primary approach. They received normofractionated (2 Gy/fraction) irradiation including associated nodal drainage sites to a cumulative dose of 70 Gy. 151 patients received additional concomitant chemotherapy (111 patients 5-fluorouracil/mitomycin C, 40 patients cisplatin-based). Toxicity during treatment was monitored weekly according to the Common Toxicity Criteria (CTC), and any toxicity grade CTC >or= 3 of mucositis, dysphagia or skin reaction was assessed as high-grade acute organ toxicity for later analysis.
  
  
  RESULTS
  A statistically significant coherency between high-grade acute organ toxicity and overall survival as well as locoregional control was found: patients with CTC >or= 3 acute organ toxicity had a 5-year overall survival rate of 44% compared to 8% in patients without (p < 0.01). Thereby, multivariate analyses revealed that the correlation was independent of other possible prognostic factors or factors that may influence treatment toxicity, especially concomitant chemotherapy and radiotherapy technique or treatment-planning procedure.
  
  
  CONCLUSIONS
  These data indicate that normal tissue and tumor tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during radio(chemo)therapy showed to be an independent prognostic marker in the own patient population. However, the authors are aware of the fact that a multivariate analysis in a retrospective study generally has statistical limitations. Therefore, their hypothesis should be further analyzed on biomolecular and clinical levels and other tumor entities in prospective trials.
authors.affiliation: Department of Radiotherapy and Radiooncology, University Medicine Göttingen, Göttingen, Germany.
authors.forename: Hendrik Andreas
authors.initials: HA
authors.lastname: Wolff
authors.forename: Jan
authors.initials: J
authors.lastname: Bosch
authors.forename: Klaus
authors.initials: K
authors.lastname: Jung
authors.forename: Tobias
authors.initials: T
authors.lastname: Overbeck
authors.forename: Steffen
authors.initials: S
authors.lastname: Hennies
authors.forename: Christoph
authors.initials: C
authors.lastname: Matthias
authors.forename: Clemens F
authors.initials: CF
authors.lastname: Hess
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Roedel
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use* / Q000633:toxicity*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D016685:Mitomycin / Q000009:adverse effects / Q000627:therapeutic use; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil