Prognostic Factors Associated With Progression-Free Survival in Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma Treated With Induction Chemotherapy Followed By Chemoradiation Therapy

Abstract

Chemoradiation therapy (CRT) is the standard of care for locally advanced head and neck squamous cell carcinoma (LAHNSCC). Induction chemotherapy (IC) with TPF (taxane, CDDP, FU) has shown benefit compared to PF (CDDP, FU), but its use is controversial. Response to IC may be associated with further response to CRT. We hypothesized that response to IC is an independent prognostic factor associated with PFS. Objective: to analyze the PFS of patients with LAHNSCC (larynx[L], hypopharynx[HP], oropharynx[OP], oral cavity[OC]), treated with IC followed by CRT, according to response to IC and CRT. Retrospective review of patients with LAHNSCC treated with IC followed by CRT from January 2010 to December 2014. Demographic characteristics, basal blood test results, type of IC, type of CRT, responses, and adverse events were collected. Patients were classified according to overall response rate (ORR) to IC and CRT, no ORR to IC but ORR to CRT, ORR to IC but not to CRT and no ORR to IC or CRT. Kaplan-Meier analysis for PFS was performed. Multivariate analysis with Cox regression was performed with variables with a P value >.1. Fifty patients were included. Mean age 54.7 yr (28-76), 36 (72%) males, 27 (54%) smoking history. OC 20 (40%), L 13 (26%), HP 10 (20%), OP 7 (14%). CS III 16 (32%), IVA 23 (46%), IVB 11 (22%). 46 (92%) ECOG 1, 4 (8%) ECOG 2. 49 (98%) TPF with cisplatin, 40 (80%) weekly (wk) taxane, 44(88%) paclitaxel, 6 (12%) docetaxel. ORR IC 80%: CR 12%, PR 68%, SD 18%, PD 2%. CRT with CDDP 41 (82%), 9 (18%) CBP. CDDP wk 20 (40%), CDDP 3wk 21 (42%). Mean CDDP dose wk 218.6 (91.37-320.71), median CDDP dose 3 wk 203.55 (94.1-308.7). Median RT dose 70 Gy (42-74), Median protraction time 8.78 wk (5-12.57). ORR CRT 84%: CR 44%, PR 40%, SD 10%, PD 6%. Univariate and multivariate results for PFS are shown in the table. Five (55%) patients with SD post-IC and 1 (100%) patient with PE post-IC achieved ORR with CRT. Response to CRT is an independent prognostic factor from response to IC for PFS. Patients responding to both treatments have the best prognosis. Patients that do not respond to IC still can benefit from CRT. CRT with CDDP should be pursued in all fit patients.Tabled 1Abstract 161VariableUnivariatepMultivariatepPFS (m)(IC95%)HR (IC95%)ORR IC and CRT ORR IC not CRT No ORR IC but ORR CRT No ORR IC or CRT55.05 (43.85-66.25)9.94 (7.19-12.69)33.45 (15.03-51.87) 9.61 (6.37-12.85)<.0001NS .021.12 (.65-1.93)NSORR (CR+PR) CRT SD PD53.63 (43.12-64.14)11.17 (8.87-13.47) 7.31 (5.9-8.71).03 <.00013.72 (1.47-9.43).006Female Male36.22 (38.2-58.35) 45.38 (36.2-54.57).081.31 (.48-3.54)NSCS III Other63.55 (48.49-78.61) 35.48 (25.71-45.2).03.26 (.081-.84).023wk CDDP Other48.86 (37.76-59.97) 39.99 (27.21-52.78.07.29 (.11-.76).01Protraction time >8wk Protraction time ≤ 8 wk42.2 (30.5-53.84) 54.1 (40.1-68.9).082.37 (.60-9.33)NS Open table in a new tab