BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is one of the leading cancers in India. Since a large majority present in loco-regionally advanced stages, surgery followed by adjuvant post-operative radiotherapy (PORT) has been the mainstay of treatment for resectable HNSCC. AIM: To identify clinico-pathologic factors that could have an impact on outcome in HNSCC in the postoperative setting. MATERIALS AND METHODS: A retrospective review of 348 previously untreated patients with HNSCC who received PORT following curative surgery. The outcome measures were local control, loco-regional control, and disease free survival (DFS). RESULTS: With a median follow-up of 36 months (range: 2-127 months) for surviving patients, the 5-year local control, loco-regional control, and DFS was 79%, 63%, and 56%, respectively for all patients. On univariate analysis, site of primary was an independent prognostic factor for all the outcome measures (P = 0.005, 0.02, and 0.04, respectively) with oral cavity lesions faring the worst. Peri-nodal extension (PNE) affected loco-regional control (P = 0.002) and DFS (P = 0.0005), but was not predictive for local control (P = 0.9852). Cut margin positivity predicted for inferior local control alone (P = 0.03), the significance of which was lost on multivariate analysis. Cox regression analysis however confirmed the significance of primary site and PNE as independent prognostic factors. CONCLUSION: Primary site and PNE are independent factors predicting outcome in the postoperative radiotherapeutic management of HNSCC.
BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is one of the leading cancers in India. Since a large majority present in loco-regionally advanced stages, surgery followed by adjuvant post-operative radiotherapy (PORT) has been the mainstay of treatment for resectable HNSCC. AIM: To identify clinico-pathologic factors that could have an impact on outcome in HNSCC in the postoperative setting. MATERIALS AND METHODS: A retrospective review of 348 previously untreated patients with HNSCC who received PORT following curative surgery. The outcome measures were local control, loco-regional control, and disease free survival (DFS). RESULTS: With a median follow-up of 36 months (range: 2-127 months) for surviving patients, the 5-year local control, loco-regional control, and DFS was 79%, 63%, and 56%, respectively for all patients. On univariate analysis, site of primary was an independent prognostic factor for all the outcome measures (P = 0.005, 0.02, and 0.04, respectively) with oral cavity lesions faring the worst. Peri-nodal extension (PNE) affected loco-regional control (P = 0.002) and DFS (P = 0.0005), but was not predictive for local control (P = 0.9852). Cut margin positivity predicted for inferior local control alone (P = 0.03), the significance of which was lost on multivariate analysis. Cox regression analysis however confirmed the significance of primary site and PNE as independent prognostic factors. CONCLUSION: Primary site and PNE are independent factors predicting outcome in the postoperative radiotherapeutic management of HNSCC.