Post-Operative Concurrent Chemoradiation for Patients with Non-Squamous Cell Carcinoma of Head and Neck: A Retrospective Cohort of the Uncommon Cancers

Abstract

Background: Non-squamous cell carcinoma of the head and neck (HNnSCCA) is a rare tumor. Surgery is the standard treatment for resectable non-metastatic patients. Post-operative radiation (RT) is indicated for high-risk patients. No data from the randomized controlled trial utilizing post-operative concurrent chemoradiation (CCRT) is available. This study was aimed to determine the benefit of post-operative CCRT in the patients with resectable non-metastatic HNnSCCA. Methods: We retrospectively reviewed data of 139 patients with HNnSCCA (excluding nasopharyngeal, neuroendocrine, and skin cancers) who underwent surgery and post-operative radiation (RT) at Siriraj Hospital from 2009-2015. Results: Ninety-nine of the 139 patients had RT alone and 40 had CCRT. More patients receiving CCRT had ≥ one high-risk feature (80% CCRT vs. 57.6% RT; p=0.018). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the groups (58.6% CCRT vs. 68.2% RT; p=0.35 and 81.7% CCRT vs. 81.0% RT; p=0.35, respectively). Interestingly, post-operative CCRT was independently associated with significantly superior DFS (hazard ratio, HR 0.29; 95% confidence interval, CI 0.10 to 0.86; p=0.02) and OS (HR 0.08; 95% CI 0.01 to 0.43; p=0.003) according to multivariable analyses. Conclusion: Post-operative CCRT was associated with better survival in high-risk patients with resectable non-metastatic HNnSCCA comparing with post-operative RT alone. Post-operative CCRT might be considered as a treatment option for these patients.

Adjuvant treatment for high‐risk salivary gland malignancies and prognostic stratification based on a 20‐year single institution experience

“…Unlike in high-risk head and neck squamous cell carcinomas, where adjuvant chemoradiation prospectively demonstrates an improvement in locoregional control and overall survival in the, 12 the benefit in high-risk salivary gland malignancies largely remains unknown. While practitioners await prospective results for a definitive answer, they are currently guided by small retrospective CRT studies, 5,6 or from large national cancer database analyses. 7 However, there remain limitations with the former having fewer patients receiving adjuvant CRT, and inherent biases within large national databases taint the comparisons between CRT and RT.…”

“…4 However, the addition of chemotherapy, used in good performance patients, has been met with mixed results and with few drugs reporting single agent activity. [5][6][7][8] Given these results, it remains possible that some drugs may still work as radiation sensitizers.…”