William A Stokes1, Arya Amini1, Bernard L Jones1, Jessica D McDermott2, David Raben1, Debashis Ghosh3, Julie A Goddard4, Daniel W Bowles2, Sana D Karam1. 1. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. 2. Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. 3. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado. 4. Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.
Abstract
BACKGROUND: Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS: 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS: On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION: Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses.
BACKGROUND: Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS: 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS: On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION: Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses.
Keywords:
Docetaxel Based Chemotherapy Plus or Minus Induction Chemotherapy to Decrease Events in Head and Neck Cancer (DeCIDE); PARADIGM; concurrent chemoradiation; induction chemotherapy; neoadjuvant chemotherapy
Authors: Natalie M Lowe; Jonathan M Bernstein; Kathleen Mais; Kate Garcez; Lip W Lee; Andrew Sykes; David J Thomson; Jarrod J Homer; Catharine M West; Nicholas J Slevin Journal: J Cancer Res Clin Oncol Date: 2017-12-08 Impact factor: 4.553
Authors: Natalie M Lowe; Lucy E Kershaw; Jonathan M Bernstein; Stephanie B Withey; Kathleen Mais; Jarrod J Homer; Nicholas J Slevin; Suzanne C Bonington; Bernadette M Carrington; Catharine M West Journal: PLoS One Date: 2018-03-28 Impact factor: 3.240
Authors: Hye Ri Han; Sung Jun Ma; Gregory M Hermann; Austin J Iovoli; Kimberly E Wooten; Hassan Arshad; Vishal Gupta; Ryan P McSpadden; Moni A Kuriakose; Michael R Markiewicz; Jon M Chan; Mary E Platek; Andrew D Ray; Fangyi Gu; Wesley L Hicks; Anurag K Singh Journal: Ann Transl Med Date: 2021-05