Abstract
BackgroundConcurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category.MethodsSixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m2) started at the first day of radiotherapy.ResultsMedian age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively).ConclusionsPoor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.
Highlights
Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours
The long-term results of ORO 93-01 trial did not reveal any statistical significance in terms of locoregional control (LRC), relapse-free survival, and overall survival (OS) among groups treated with conventional fractionation, altered fractionation and concurrent radiochemotherapy (CRCT), the authors concluded that considering the almost double increase in the 5-year LRC, relapse-free survival, and OS rates achieved with the use of CRCT, this combined treatment approach should be recommended for patients with advanced squamous cell carcinomas of the oropharynx [48]
The results of prospective phase II randomized single-centre study conducted by Sharma et al [25] comparing radical radiotherapy with CRCT with seven doses of weekly cisplatin in patients with advanced carcinoma of the oropharynx and nasopharynx confirmed the superiority of CRCT over radiotherapy alone resulting in higher OS rates
Summary
Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The tonsil is the most frequently represented subsite of the primary oropharyngeal carcinoma followed by the base of tongue [6,7]. These two subsites account for between 80–90% of cases [2]. Most of the primary tumours presents at an advanced stage (T2 or greater) [10], and the incidence of nodal metastases ranges between 60-70% [11,12] which is probably related to the rich lymphatic supply of the dominant subsites of the oropharyngeal cancers
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