Radiotherapy Benefit Underestimated in Head and Neck Cancer

Allison Gandey

July 24, 2007

July 24, 2007 (Chicago) –- The absolute benefit of radiotherapy tends to be underestimated because patients with poor prognostic factors are more frequently selected for treatment, researchers suggest. In the largest reported analysis of adjuvant radiotherapy in advanced head and neck squamous-cell carcinoma, treatment resulted in an approximately 10% absolute increase in 5-year cancer-specific and overall survival. The findings were presented at the recent American Society of Clinical Oncology 43rd Annual Meeting.

"Although adjuvant radiotherapy is often recommended for locally advanced head and neck squamous-cell carcinoma, its effect on overall or cancer-specific survival has not been clearly demonstrated," presented lead author Amir Lavaf, MD, from the Mount Sinai School of Medicine, in New York. "This analysis included 13,145 patients from the Surveillance, Epidemiology, and End Results [SEER] database."

The investigators selected patients with locally invasive node-negative (SEER stage 2) or node-positive head and neck cancer (SEER stage 3 to 4) and treated patients either with surgery alone or with surgery and radiation. The median follow-up was 4.7 years.

Adjuvant Radiotherapy Led to About a 10% Absolute Increase in 5-Year Cancer Specific and Overall Survival

Adjuvant radiotherapy was given to 55% of patients with stage 2 and 84% of patients with stage 3 and 4 head and neck cancer. The researchers found that for stage 2 disease, adjuvant radiotherapy was associated with lower 5-year overall survival on univariate analysis (46.3% for surgery with radiation vs 49.8% for surgery alone; P = .016). But this was not the case on multivariate analysis (hazard ratio, 1.00, P = .93).

For stage 3 head and neck cancer, radiotherapy improved 5-year overall survival associated with radiotherapy on univariate analysis (52% for surgery with radiation vs 41% for surgery alone; P < .001), and on multivariate analysis, the hazard ratio was .80; P = .002.

For stage 4 disease, radiotherapy significantly improved 5-year overall survival on univariate analysis (35% for surgery plus radiotherapy vs 25% for surgery alone, P < .001), and on multivariate analysis, the hazard ratio was .75; P < .001. Dr. Lavaf showed the addition of radiotherapy improved 5-year cancer-specific survival for both stage 3 (59.7% vs 51.4%) and stage 4 head and neck cancers (42.1% vs 32.8%).

The researchers conclude the absolute benefit of adjuvant therapy for locally advanced head and neck squamous-cell carcinoma tends to be underestimated. They suggest this may be due to the fact that patients with poor prognostic factors are more frequently selected for treatment. "Outcomes in this high-risk population remain suboptimal," Dr. Lavaf noted, "emphasizing the need for continued investigation of innovative treatment approaches."

American Society of Clinical Oncology 43rd Annual Meeting: Abstract 6087. Presented June 4, 2007.

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