title: Survival of patients with head and neck cancer. Impact of physical status and comorbidities.
abstract: BACKGROUND
  Prognostic factors (e.g., gender, tumor stage, and hypoxia) have an impact on survival in patients with head and neck cancer. Thus, the impact of physical status and comorbidities on treatment decision and survival were evaluated.
  
  
  METHODS
  A total of 169 primary, inoperable patients with squamous cell cancer of the head and neck were retrospectively investigated. Patients were treated with hyperfractionated accelerated radio(chemo)therapy (HARcT) or hypofractionated radio(chemo)therapy (HypoRcT). Depending on the individual patient's situation (Karnofsky Performance Index, KPI), treatment for patients with a KPI of 80-100% was generally radiochemotherapy and for patients with a KPI ≤ 70% treatment was radiotherapy alone. In addition, all comorbidities were evaluated. Uni- and multivariate proportional hazards model were used, and overall survival (OS) was estimated by the Kaplan-Meier method.
  
  
  RESULTS
  Treatment consisted of HARcT for 76 patients (45%), HART for 28 patients (17%), HypoRcT for 14 patients(8%), and HypoRT for 51 patients (30%). Of the patients, 107 patients (63%) presented with a KPI of 80-100%. OS (20%) was significantly better for patients with a KPI of 80-100%, while the OS for patients with a KPI ≤ 70% was 8% (p < 0.001). Good KPI, total irradiation dose (> 70 Gy), and chemotherapy were significant prognostic factors for better OS.
  
  
  CONCLUSIONS
  Our retrospective analysis shows that performance status with dependency on comorbidities was an independent risk factor for OS.
authors.affiliation: Clinic of Radiotherapy, Friedrich Alexander University, Erlangen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Sadat
authors.forename: A
authors.initials: A
authors.lastname: Wienke
authors.forename: J
authors.initials: J
authors.lastname: Dunst
authors.forename: T
authors.initials: T
authors.lastname: Kuhnt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D015897:Comorbidity; D019583:Dose Fractionation, Radiation; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality; D012307:Risk Factors