Effect of Adjuvant Chemoradiotherapy in Resected Locally Advanced Head and Neck Cancer
In a study of National Cancer Database data reported in the Journal of Clinical Oncology, Trifiletti et al found that adjuvant chemoradiotherapy was associated with a survival benefit in patients with resected locally advanced head and neck cancer with negative surgical margins and no extracapsular extension. The effect varied according to lymph node involvement.
Study Details
The study involved data from the National Cancer Database on 10,870 patients diagnosed in 2004 to 2012 with stage III to IVB squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx treated with definitive surgery and adjuvant radiotherapy or chemoradiotherapy who had negative surgical margins and no extracapsular extension.
Chemoradiotherapy and Survival Outcomes
Among the 10,870 patients, 47% received adjuvant chemoradiotherapy. On multivariate analysis, use of chemoradiotherapy was significantly more likely according to several factors, including more advanced nodal disease, increased number of involved nodes, presence of oropharyngeal tumors, lower neck disease, treatment in nonacademic facilities, male sex, patient age < 65 years, and residence within 100 miles from the treatment facility.
In a propensity score–weighted Cox proportional hazards model, chemoradiotherapy was associated with a survival benefit vs radiotherapy alone among all patients (hazard ratio [HR] = 0.90, P < .001). Hazard ratios according to nodal involvement were 1.073 (P = .122) with 0 nodes, 0.877 (P = .007) with 1 node, 0.840 (P < .001) with 2 to 4 nodes, and 0.876 (P = .029) with 5 or more nodes. Three-year and 5-year overall survival rates with chemoradiotherapy vs radiotherapy were 74.2% vs 71.8% and 65.3% vs 62.4% among all patients, 73.6% vs 75.1% and 62.1% vs 64.2% for 0 nodes involved, 81.8% vs 79.5% and 75.9% vs 73.0% for 1 node involved, 71.0% vs 66.6% and 61.8% vs 56.4% for 2 to 4 nodes, and 62.9% vs 58.9% and 51.8% vs 47.2% for 5 or more nodes, respectively.
The investigators concluded: “The use of adjuvant [chemoradiotherapy] in patients with resected [locally advanced head and neck cancer] with [surgical margin] negative and no [extracapsular extension] is common. Substantial practice variation as well as the survival differences observed in this study support the conduct of additional research to guide personalized treatment approaches in this setting. The number of positive lymph nodes seems to be an appropriate selection factor for further investigation of [chemoradiotherapy] in such patients.”
Samuel Swisher-McClure, MD, of the University of Pennsylvania School of Medicine in Philadelphia, is the corresponding author of the Journal of Clinical Oncology article.
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