Abstract
BackgroundCurrently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified.ObjectivesTo assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients.Materials and methodsWe used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan–Meier and multivariate Cox regression (models adjusted for HPV-related cancer site).ResultsTemporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35–0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03).ConclusionThe advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery.
Highlights
The incidence of head and neck cancer (HNC) reaches approximately 4–5/100,000 inhabitants per year, and it is twice as prevalent among men compared to women.[1]
In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35–0.85, p = 0.003)
The advent of intensity-modulated radiotherapy (IMRT), additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery
Summary
The incidence of head and neck cancer (HNC) reaches approximately 4–5/100,000 inhabitants per year, and it is twice as prevalent among men compared to women.[1] In recent decades, increases in the incidence were mostly confined to women, with a rise in the incidence of papilloma virus (HPV) infections contributing.[1, 2]. Retrospective studies have demonstrated a lower risk of recurrence and an improved OS for PORT in high-risk situations.[4,5,6,7] There is some debate regarding the effectiveness of post-operative radiotherapy in head and neck tumours in localised stages (T1/2) with solitary affected lymph nodes (N1).[8]. The role of adjuvant irradiation in head and neck cancer (HNC) patients with N1lymph node status is not clarified
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