title: Results of concurrent radio-chemotherapy for the treatment of head and neck squamous cell carcinoma in everyday clinical practice with special reference to early mortality.
abstract: BACKGROUND
  Randomized controlled trials have established concurrent chemo-radiotherapy as the preferred treatment option for inoperable local-regionally advanced head and neck squamous cell carcinomas (HNSCCs). Because many patients have multiple co-morbidities and would not fulfill the eligibility criteria of clinical trials, the results need to be re-evaluated in daily clinical practice with special reference to early mortality.
  
  
  METHODS
  167 consecutive patients with HNSCC who received concurrent chemo-radiotherapy at the Basel University Hospital between 1988 and 2006 were analyzed retrospectively with a special focus on early deaths and risk factors for an unfavorable outcome.
  
  
  RESULTS
  In our cohort, the 3- and 5-year overall survival rates were 54% and 47%, respectively. The therapy was associated with relevant toxicity and an early mortality rate of 5.4%. Patients dying early were analyzed individually for the cause of death. Patients with elevated white blood cell counts (HR: 2.66 p=0,016) and vascular co-morbidities (HR: 5.3, p=0,047) showed significantly worse survival rates. The same factors were associated with a trend toward increased treatment-related mortality. The 3-year survival rate improved from approximately 43% for patients treated before the year 2000 to 65% for patients treated after the year 2000 (Fisher's exact test p=0.01).
  
  
  CONCLUSIONS
  Although many patients who received concurrent chemo-radiotherapy would not have qualified for clinical trials, the outcome was favorable and has significantly improved in recent years. However the early mortality was slightly worse than what is described in the literature.
authors.forename: Michael
authors.initials: M
authors.lastname: Schlumpf
authors.forename: Claude
authors.initials: C
authors.lastname: Fischer
authors.forename: Diana
authors.initials: D
authors.lastname: Naehrig
authors.forename: Christoph
authors.initials: C
authors.lastname: Rochlitz
authors.affiliation: Head and Neck Cancer Center, Basel University Hospital, Division of Medical Oncology, Division of Radio-oncology, Division of the ENT Clinic Basel University Hospital, Hebelstrasse 20, CH-4031 Basel, Switzerland. Martin.Buess@claraspital.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Buess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D059248:Chemoradiotherapy / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin