Yungan Tao1, Anne Aupérin2, Pierre Graff3, Michel Lapeyre4, Vincent Grégoire5, Philippe Maingon6, Lionel Geoffrois7, Pierre Verrelle4, Gilles Calais8, Bernard Gery9, Laurent Martin10, Marc Alfonsi11, Patrick Deprez12, Etienne Bardet13, Thierry Pignon14, Michel Rives3, Christian Sire15, Jean Bourhis16. 1. Institut Gustave Roussy, Villejuif, France. Electronic address: yungan.TAO@gustaveroussy.fr. 2. Institut Gustave Roussy, Villejuif, France. 3. Centre Claudius Regaud, Toulouse, France. 4. Centre Jean Perrin, Clermont-Ferrand, France. 5. Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium. 6. Centre Georges-François Leclerc, Dijon, France. 7. Centre Alexis Vautrin, Nancy, France. 8. CHU Bretonneau Tours, France. 9. Centre François Baclesse, Caen, France. 10. Centre Guillaume Le Conquérant, Le Havre, France. 11. Clinique Sainte-Catherine, Avignon, France. 12. Clinique d'oncologie Saint-Yves, Vannes, France. 13. Centre René Gauducheau, Nantes, France. 14. Centre Hospitalier Universitaire La Timone, Marseille, France. 15. Centre Hospitalier de Lorient, France. 16. Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Abstract
OBJECTIVE: To analyze the outcome of N3 patients treated with very accelerated radiotherapy (VART) or different schedules of concurrent chemoradiotherapy (CRT) within two phase III trials. PATIENTS AND METHODS: Data of 179 patients with N3 HNSCC from two GORTEC randomized trials (96-01 and 99-02) were pooled. Patients received either VART: 64.8Gy/3.5weeks or one of the 3 following CRT regimens: Conventional CRT: 70Gy/7weeks+3 cyclescarboplatin-5FU; Moderately accelerated CRT: 70Gy/6weeks+2 cycles carboplatin-5FU; Strongly intensified CRT: 64Gy/5weeks+cisplatin (days 2, 16, 30) and 5 FU (days 1-5, 29-33) followed by 2 cycles adjuvant cisplatin-5FU. RESULTS: Median follow-up was 13.3 and 5.2years for GORTEC 96-01 and GORTEC 99-02, respectively. Five-year overall survival (OS) was 13.8%. No significant difference was observed between CRT versus VART in terms of OS (hazard ratio [HR]: 0.93, p=0.68), loco-regional progression (HR: 0.70, p=0.13), or distant progression (HR: 0.86, p=0.53). OS was worse for patients with T3-4 tumors versus early T stage (11.0% versus 25.7%, p=0.015). In multivariate analysis, the oropharyngeal subsite presented a higher risk of distant metastasis (as first event 46.5% vs 19.2%, p<0.001),). A significant interaction between treatment modalities and subsites has been observed concerning loco-regional and distant failures. CONCLUSION: The outcome of N3 HNSCC was extremely poor despite treatment intensification and no difference between CRT and VART. Both distant metastases and loco-regional failures remain important treatment challenge.
RCT Entities:
OBJECTIVE: To analyze the outcome of N3 patients treated with very accelerated radiotherapy (VART) or different schedules of concurrent chemoradiotherapy (CRT) within two phase III trials. PATIENTS AND METHODS: Data of 179 patients with N3 HNSCC from two GORTEC randomized trials (96-01 and 99-02) were pooled. Patients received either VART: 64.8Gy/3.5weeks or one of the 3 following CRT regimens: Conventional CRT: 70Gy/7weeks+3 cycles carboplatin-5FU; Moderately accelerated CRT: 70Gy/6weeks+2 cycles carboplatin-5FU; Strongly intensified CRT: 64Gy/5weeks+cisplatin (days 2, 16, 30) and 5 FU (days 1-5, 29-33) followed by 2 cycles adjuvant cisplatin-5FU. RESULTS: Median follow-up was 13.3 and 5.2years for GORTEC 96-01 and GORTEC 99-02, respectively. Five-year overall survival (OS) was 13.8%. No significant difference was observed between CRT versus VART in terms of OS (hazard ratio [HR]: 0.93, p=0.68), loco-regional progression (HR: 0.70, p=0.13), or distant progression (HR: 0.86, p=0.53). OS was worse for patients with T3-4 tumors versus early T stage (11.0% versus 25.7%, p=0.015). In multivariate analysis, the oropharyngeal subsite presented a higher risk of distant metastasis (as first event 46.5% vs 19.2%, p<0.001),). A significant interaction between treatment modalities and subsites has been observed concerning loco-regional and distant failures. CONCLUSION: The outcome of N3 HNSCC was extremely poor despite treatment intensification and no difference between CRT and VART. Both distant metastases and loco-regional failures remain important treatment challenge.
Authors: Ambika Parmar; Michaelina Macluskey; Niall Mc Goldrick; David I Conway; Anne-Marie Glenny; Janet E Clarkson; Helen V Worthington; Kelvin Kw Chan Journal: Cochrane Database Syst Rev Date: 2021-12-20
Authors: Christiane Matuschek; Jan Haussmann; Edwin Bölke; Stephan Gripp; Patrick J Schuler; Bálint Tamaskovics; Peter Arne Gerber; Freddy-Joel Djiepmo-Njanang; Kai Kammers; Christian Plettenberg; Bahar Anooshahr; Klaus Orth; Wilfried Budach Journal: Radiat Oncol Date: 2018-10-04 Impact factor: 3.481