Pretreatment probability model for predicting outcome after intraarterial chemoradiation for advanced head and neck carcinoma

Abstract

BACKGROUNDConcurrent chemoradiation is being used increasingly to treat patients with advanced‐stage head and neck carcinoma. In the current study, a clinical nomogram was developed to predict local control and overall survival rates for individual patients who will undergo chemoradiation.METHODSNinety‐two consecutive patients with UICC TNM Stage III/IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and supraglottic larynx were treated with selective‐targeted chemoradiation (acronym: RADPLAT). All living patients had a minimum follow‐up of 2 years. In addition to general factors, the following parameters were analyzed in a multivariable analysis: primary tumor volume, lymph node tumor volume, total tumor volume, lowest involved neck level, comorbidity, pretreatment hemoglobin level, pretreatment weight loss, and unilateral/bilateral intraarterial infusion. Relevant factors for local control and survival were analyzed using the Cox proportional hazards model.RESULTSAt 5 years, the local control and overall survival rates for the whole group were 60% and 38%, respectively. Primary tumor volume (hazard ratio [HR], 1.03; P = 0.01) and unilateral infusion (HR, 5.05; P = 0.004) were found to influence local control significantly. Using tumor volume as a continuous variable, an adjusted risk ratio of 1.026 was found, indicating that each 1‐cm3 increase in volume was associated with a 2.6% decrease in probability of local control. Primary tumor volume (HR, 1.01; P = 0.003), comorbidity (American Society of Anesthesiologists [ASA] physical status 1 vs. > 1; HR, 2.47; P = 0.01), lowest involved neck level (HR, 3.45; P = 0.007), and pretreatment weight loss > 10% (HR, 2.04; P = 0.02) were found to be significant predictors of worse overall survival. Variables from the multivariable analysis were used to develop a nomogram capable of predicting local control and overall survival.CONCLUSIONSTumor volume was found to play a significant role in predicting local control and overall survival in patients with advanced‐stage head and neck carcinoma who were treated with targeted chemoradiation. The nomograms may be useful for pretreatment selection of patients with advanced‐stage head and neck carcinoma. Cancer 2004. © 2004 American Cancer Society.

RADPLAT: An Alternative to Surgery?

“…Reported risk factors for distant metastasis included N stage (p = .02), primary tumor in the hypopharynx (p = .01), lower neck involvement (p = .002), number of neck levels involved (p = .001), and bilateral nodal disease (p = .02). Similar results were described by van den Broek et al [57] Alkureishi, de Bree, Ross 475 www.TheOncologist.com in a series of 92 patients, with tumor volume (p = .003), lowest involved neck level (p = .007), pretreatment weight loss >10% (p = .02), and associated comorbidity (p = .01) all found to significantly influence survival following RAD-PLAT treatment.…”

“…A reliable pretreatment probability model for predicting outcome after RAD-PLAT is needed to select patients with resectable tumors who are likely to benefit from chemoradiation. If RAD-PLAT is unlikely to cure patients with resectable tumors, these patients should instead be treated with primary surgery [57].…”

Molecular markers predict outcome in squamous cell carcinoma of the head and neck after concomitant cisplatin‐based chemoradiation

“…Since tumor volume is a strong predictor of outcome 8,9 in advanced head and neck squamous cell carcinomas, we looked for Intermediate group. LC, local control; OS, overall survival; nm, not mentioned; u, univariable analysis; m, multivariable analysis.…”

“…However, in patients with advanced head and neck cancer it has been demonstrated that T and N stage do not have sufficient predictive value. 8,9 Tumor volume has been shown to be the most predictive factor for LC. [8][9][10][11][12] For OS, tumor volume, comorbidity, lowest involved neck level and pretreatment weight loss have been found to be prognostic.…”

Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer

“…10,11 In addition, patients with critical weight loss reported lower quality-of-life scores and poorer treatment tolerance. 7,[12][13][14] Several studies have shown nutritional interventions in HN cancer patients to have a positive impact on their nutritional status, quality of life, and treatment compliance.…”