Impact of tumor control and presence of visible necrosis in head and neck cancer patients treated with radiotherapy or radiochemotherapy |
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Authors: | Email author" target="_blank">Thomas?KuhntEmail author Arndt-Christian?Mueller Tanja?Pelz Gabriele?Haensgen Marc?Bloching Sabrina?Koesling Johannes?Schubert Juergen?Dunst |
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Institution: | (1) Clinic of Radiotherapy, Martin Luther University Halle Wittenberg, Dryanderstrasse 4, 06097 Halle/Saale, Germany;(2) Clinic of Head and Neck Surgery, Martin Luther University Halle Wittenberg, Magdeburger Street 12, 06097 Halle/Saale, Germany;(3) Clinic of Diagnostic Radiology, Martin Luther University Halle Wittenberg, Ernst Grube Street 40, 06097 Halle/Saale, Germany;(4) Clinic of Oral, Maxillo-and Plastic Facial Surgery, Martin Luther University Halle Wittenberg, Ernst Grube Street 40, 06097 Halle/Saale, Germany |
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Abstract: | Purpose: Tumor volume after the lymph node involvement is one of the most important single prognostic factor in patients of head
and neck cancers treated with radiotherapy. We have recently demonstrated that the hypoxic subvolume is more important than
the total tumor volume. We therefore propose the hypothesis that the presence of visible necrosis might be an important factor
for cure by radiotherapy in squamous cell cancers of the head and neck. Methods: A total of 51 patients with locally advanced inoperable (T3-4 or N2-3) squamous cell cancers of the head and neck (mean
age 57 years, range 41–75 years) were prospectively investigated with regard to a possible impact of tumor volume. All patients
received CT examination of the head and neck according to a standardized protocol (spiral CT, contrast enhancement after automatic
injection), and the total tumor volume was calculated as the sum of volumes of all visible macroscopic tumor sites. Poorly
perfused and necrotic areas (no contrast enhancement) within macroscopic tumor sites were also calculated. Patients were then
treated with accelerated-hyperfractionated radiotherapy in about 6 weeks. Seventeen patients were treated with only radiation.
Patients without contraindications to cisplatin chemotherapy received cisplatin chemotherapy or a combination of cisplatin
and paclitaxel (N=34). The allocation of patients to certain treatment regimens was based on individual decisions in each case and not randomized.
Results: In patients treated with radiation alone, 12/17 (71%) got recurrence whereas in patients treated with radiation plus cisplatin,
only 14/34 (41%) recurred (P=0.05). The 2-year overall survival was for radiation alone versus radiation plus cisplatin 0% vs. 62% (P<0.0008). Tumors with smaller amount of necrosis (necrosis volume<4 cm3) had a good prognosis irrespective of type of treatment (radiation alone or radiation plus cisplatin). However, patients
with tumors with a larger amount of necrosis (necrosis volume≥4 cm3) had a significantly better outcome if they were treated with radiation plus cisplatin as compared to patients treated with
radiation alone. In a multi-variate analysis using a Cox-regression model the type of treatment (radiotherapy plus versus
without cisplatin) was the only independent prognostic factor for event-free survival (P<0.03) in the whole group. Conclusions: In this non-randomized retrospective investigation with limited sample size, radiation plus cisplatin was superior to radiation
alone. This resulted mainly from a higher efficacy of the radiochemotherapy regimen in patients with large and especially
necrotic tumors. The prognostic and predictive impact of visible necrosis should be further evaluated. |
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Keywords: | Head and neck cancer CT scan Tumor volume Necrosis volume Radiotherapy Radiochemotherapy |
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