BACKGROUND: It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT. METHODS: The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor‐prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5‐fluorouracil, hydroxyurea, and a third agent. RESULTS: One hundred sixty‐six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow‐up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2‐year rates for OS, disease‐free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty‐three patients (19.9%) died of treatment‐related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2‐year OS rate, 10.8% vs 28.4%; P = .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full‐dose ReRT, and radiotherapy interval. CONCLUSIONS: CReRT achieved a long‐term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients. Cancer 2011;. © 2011 American Cancer Society.
Promising control and functional outcomes are achieved with TFHX for T4 laryngeal patients. LVT4 disease had outcomes similar to patients with less advanced disease treated on Radiation Therapy Oncology Group 91-11. Induction chemotherapy improved outcomes, warranting further investigation.
; 312.926.2520. TJK and WRB were responsible for statistical analyses Compliance with ethical standards: Conflict of interest: WRB's reports travel expenses from AAPM, and honoraria from Augmenix Inc. These do not pertain to this work and WRB declares he has no conflict of interest with regard to this study. TJK is on a speaker's bureau for AstraZeneca, has served as a consultant to Varian Medical Systems and was on an advisory board for Abbvie Inc. These do not pertain to this work and TJK declares he has no conflict of interest with regard to this study. CT is on a speaker's bureau for Merck and Varian Medical Systems, advisory board for Novocure. These do not pertain to this work and CT declares she has no conflict of interest with regard to this study. TJCW reports travel expenses from Abbvie, AstraZeneca, and Elekta, serves as a consultant for Abbvie, Merck, Doximity, and Elekta, is on advisory boards for American Cancer Society of New Jersey and AstraZeneca, and Honoria from Elekta and Wolthers Kluwer, and stock options from Doximity. These do not pertain to this work and TJCW declares he has no conflict of interest with regard to this study. MPM has served as a consultant to Agenus, Insys, Remedy, IBA, Varian, Oncoceutics, Astra-Zeneca, Celgene, Tocagen, and is on the DSMB of Monteris, and the Board of Oncoceutics. These do not pertain to this work and MPM declares he has no conflict of interest with regard to this study. KPM has served as a consultant for Via Oncology Pathways; this does not pertain to this work and KPM declares he has no conflict of interest with regard to this study. MMK reports a research grant from EpicentRX, which does not pertain to this work and MMK declares she has no conflict of interest with regard to this study. AAS has participated in an advisory committee, received travel expenses, received honoraria, and received research funding from Blue Earth Diagnostics, as well as travel expenses and honoraria from DAVA Oncology; this does not pertain to this work and AAS declares he has no conflict of interest with regard to this study. SNB, JAB, AJG, SS do not have relevant financial relationships to disclose and declare they have no conflicts of interest with regard to this study.
Background Although blacks experience worse outcomes after treatment for squamous cell carcinoma of the head and neck (HNSCC), these conclusions were based on populations where blacks comprised a minority of patients. Here, we determined the impact of race on outcomes in HNSCC patients treated with radiotherapy at an institution where blacks comprise the majority of patients. Methods We performed a retrospective cohort study by reviewing 366 black and 236 white patients with non-metastatic HNSCC treated with radiotherapy between 1990 and 2012. The primary study outcome measurements were locoregional control, freedom from distant metastasis, progression-free survival, and overall survival. Results Median follow-up was 18.3 months for all patients. The 2-year locoregional control was 71.9% for blacks compared to 64.2% for whites (HR 0.72; P = .03). There was no difference between blacks and whites regarding 2-year freedom from distant metastasis, progression-free survival, and overall survival. For Stage III–IVB patients, blacks had similar outcomes as white patients. On multivariate analysis, race was not statistically significant for locoregional control, freedom from distant metastasis, progression free survival or overall survival. Despite these similar outcomes, black patients had worse socioeconomic factors as well as increased comorbidities but similar treatment compliance. Conclusions With more adverse prognostic factors, black patients experienced similar oncologic outcomes as white patients after radiotherapy for HNSCC. Our data suggests that centers treating large percentages of minority patients with radiotherapy for HNSCCs may overcome existing healthcare disparities through improved treatment compliance.
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