Diana N Kirke1, Muhammad M Qureshi2, Sophia C Kamran3, Waleed Ezzat1, Scharukh Jalisi1, Andrew Salama4, Peter C Everett5, Minh Tam Truong2. 1. Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts. 2. Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts. 3. Harvard Radiation Oncology Program, Boston, Massachusetts. 4. Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts. 5. Division of Hematology Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Abstract
BACKGROUND: The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC). METHODS: Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. RESULTS: Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124). CONCLUSION: In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
BACKGROUND: The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC). METHODS: Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. RESULTS: Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124). CONCLUSION: In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
Authors: Alexander N Goel; Sophia Sangar; Laith Mukdad; Chase M Heaton; William R Ryan; Marilene B Wang; Jennifer L Long; Maie A St John Journal: Head Neck Date: 2019-05-20 Impact factor: 3.147