title: Late toxicity after radical treatment for locally advanced head and neck cancer.
abstract: BACKGROUND
  Multimodal treatment for locally advanced head and neck carcinomas (LAHNC) has been reported to improve survival. However, it is less clear to what extent this survival gain is given at the expense of an impact on the quality of life of our patients. Our aim is to analyze the ongoing late toxic effects among long survivors, to determine how much these impairments affect their QoL, and if there is any factor that clearly impacts on this toxicity.
  
  
  METHODS
  152 Patients diagnosed with LAHNC were treated radically in our clinical practice, either with concomitant chemoradiotherapy or bioradiotherapy, with or without induction chemotherapy. We prospectively assessed these patients' treatment-related late toxicities according to the Radiation Therapy Oncology Group scoring system, and patients answered a QoL question to subjectively evaluate the degree of impact caused by these sequelae in their daily life. Multivariate logistic regressions were performed to detect factors that could influence in toxicity.
  
  
  RESULTS
  21.9% Patients experienced grade 3-4 toxicity. Concomitant chemoradiation with cisplatin was found to be a risk factor of moderate and severe late toxicity compared to concomitant cetuximab in the adjusted analysis by RT fractionation. OR for moderate toxicity 0.292 (CI: 0.125-0.680, p=0.004); OR for severe toxicity: 0.299 (CI: 0.0909-0.999, p=0.05). Induction chemotherapy was found to be a protective factor for moderate late toxicity compared to concomitant treatment alone.
  
  
  CONCLUSIONS
  Patients treated with concomitant chemoradiation with cisplatin have significantly more late toxicity compared to bioradiotherapy, whereas induction chemotherapy prevents from developing moderate late toxicity.
authors.affiliation: Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain. Electronic address: mtaberna@iconcologia.net.
authors.forename: Miren
authors.initials: M
authors.lastname: Taberna
authors.affiliation: Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain.
authors.forename: Antonio José
authors.initials: AJ
authors.lastname: Rullan
authors.affiliation: Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Spain.
authors.forename: Cinta
authors.initials: C
authors.lastname: Hierro
authors.affiliation: Statistics Unit, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vázquez
authors.affiliation: Radiotherapy Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Lozano
authors.affiliation: Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Vilajosana
authors.affiliation: ENT Department, Bellvitge University Hospital, Barcelona, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Maños
authors.affiliation: Maxillofacial Surgery Department, Bellvitge University Hospital, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marí
authors.affiliation: Plastic and Reconstructive Surgery Department, Head and Neck Unit, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Viñals
authors.affiliation: Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain; Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain; Universitat de Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Mesía
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D000068818:Cetuximab / Q000008:administration & dosage / Q000009:adverse effects*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068818:Cetuximab; D002945:Cisplatin
keywords: Cetuximab; Cisplatin; Head and neck cancer; Late toxicity; Locally advanced head and neck carcinomas; Long survivors; Quality of life; Quality of life (QoL); Radiotherapy