Is concurrent chemoradiation the treatment of choice for all patients with Stage III or IV head and neck carcinoma?
Open Access
- 9 February 2004
- Vol. 100 (6), 1171-1178
- https://doi.org/10.1002/cncr.20069
Abstract
BACKGROUND Many patients with small primary tumors of the oropharynx have AJCC Stage III/IV disease on the basis of lymphadenopathy. In the current retrospective study, the authors hypothesized that these patients have high rates of locoregional control when treated with radiotherapy, either alone or combined with neck surgery, and may not require concurrent chemotherapy. METHODS Two hundred ninety‐nine patients met staging and inclusion criteria. Stage distribution was as follows: T1, 99 patients (33%); T2, 182 patients (61%); Tx, 18 patients (6%); N1, 74 patients (25%); N2, 170 patients (57%); N3, 39 patients (13%); and Nx, 16 patients (5%). Primary tumor resection or tonsillectomy had been performed in 36 patients (12%) and excisional lymph node biopsy or formal neck dissection in 192 patients (64%). Thirty‐three additional patients (10%) received chemotherapy and were analyzed separately. RESULTS The median follow‐up was 82 months (range, 8–299 months). The actuarial 5‐year rates of locoregional failure, distant metastases, and overall survival were 15%, 19%, and 64%, respectively. T status was associated with the 5‐year rate of locoregional control: 95% for patients with T1‐/Tx disease, compared with 79% for patients with T2 disease (P < 0.01). The 5‐year rate of distant metastases for patients with N1/2a disease was 11%, compared with 28% for patients with N2b/N2c/N3 disease (P < 0.001). CONCLUSIONS Patients with early–T status oropharyngeal carcinoma, which is considered advanced due to the presence of lymphadenopathy, have high rates of locoregional control when treated with radiotherapy without or with neck surgery. Local treatment intensification by the addition of concurrent chemotherapy to radiotherapy would not significantly benefit most of these patients. Cancer 2004. © 2004 American Cancer Society.Keywords
This publication has 25 references indexed in Scilit:
- Human papillomavirus positive squamous cell carcinoma of the oropharynxCancer, 2001
- Importance of Comorbidity in Head and Neck CancerThe Laryngoscope, 2000
- Hyperfractionated Irradiation with or without Concurrent Chemotherapy for Locally Advanced Head and Neck CancerNew England Journal of Medicine, 1998
- Larynx Preservation in Pyriform Sinus Cancer: Preliminary Results of a European Organization for Research and Treatment of Cancer Phase III TrialJNCI Journal of the National Cancer Institute, 1996
- Base-of-tongue carcinoma: Treatment results using concomitant boost radiotherapyInternational Journal of Radiation Oncology*Biology*Physics, 1995
- Purposes, Problems, and Proposals for Progress in Cancer StagingJAMA Otolaryngology–Head & Neck Surgery, 1995
- Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: Report of intergroup study 0034International Journal of Radiation Oncology*Biology*Physics, 1992
- Treatment selection for carcinoma of the base of the tongueThe American Journal of Surgery, 1990
- Definitive radiotherapy for squamous cell carcinoma of the tonsillar fossaInternational Journal of Radiation Oncology*Biology*Physics, 1989
- Treatment of choice for squamous carcinoma of the tonsillar fossaHead & Neck Surgery, 1985