Oncotarget

Clinical Research Papers:

Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma

Junlin Yi, Xiaodong Huang, Zhengang Xu, Shaoyan Liu, Xiaolei Wang, Xiaohui He, Dehong Luo, Jingwei Luo, Jianping Xiao, Shiping Zhang, Kai Wang, Yuan Qu, Yuan Tang, Weixin Liu, Guozhen Xu, Li Gao _ and Dian Wang

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Oncotarget. 2017; 8:44842-44850. https://doi.org/10.18632/oncotarget.15107

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Abstract

Junlin Yi1, Xiaodong Huang1, Zhengang Xu2, Shaoyan Liu2, Xiaolei Wang2, Xiaohui He3, Dehong Luo4 , Jingwei Luo1, Jianping Xiao1, Shiping Zhang1, Kai Wang1, Yuan Qu1, Yuan Tang1, Weixin Liu1, Guozhen Xu1, Li Gao1 and Dian Wang5

1 Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China

2 Department of Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China

3 Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China

4 Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China

5 Department of Radiation Oncology, Rush University Medical Center, Chicago, USA

Correspondence to:

Li Gao, email:

Keywords: head and neck squamous cell carcinoma; preoperative radiotherapy; concurrent chemoradiotherapy; multimodality treatment; organ function preservation

Received: November 22, 2016 Accepted: January 11, 2017 Published: February 05, 2017

Abstract

Purpose: To determine the role of preoperative concurrent chemoradiotherapy in the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC).

Methods: A total of 222 patients with stage III/IVA-B HNSCC were randomly assigned to receive preoperative concurrent chemoradiotherapy (Pre-S CRT, weekly cisplatin 30mg/m2) or preoperative radiotherapy alone (Pre-S RT). Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test.

Results: With a medial follow-up of 59 month, the 5-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) of Pre-S CRT v Pre-S RT group were 53.8% v 39.0% (hazard ratio [HR], 0.74, 95% CI, 0.50 to 1.10, P = 0.13), 53.2% v 38.7%, (HR, 0.69, 95% CI, 0.47 to 1.01, P =0.06), and 80.4% v 68.1% (HR, 0.53, 95% CI, 0.28 to 0.98, P = 0.04), respectively. In patients with larynx-hypopharynx primaries, the 5-year OS, PFS and DMFS of Pre-S CRT v Pre-S RT were 62.7% v 38.8% (HR, 0.59, 95% CI 0.35 to 1.02, P = 0.054), 63.1% v 39.9% (HR, 0.52; 95% CI 0.30 to 0.89, P = 0.03) and 86.2% v 63.3% (HR, 0.35, 95% CI 0.15 to 0.82, P = 0.01), respectively.

Conclusion: The addition of weekly cisplatin concurrent to preoperative RT does not improve OS, but improve DMFS in locally advanced HNSCC. However, in a subset of patients with the larynx-hypopharynx primaries, preoperative chemoradiotherapy has significantly improved PFS and DMFS, and has also provided a borderline benefit in OS in comparison with preoperative radiotherapy alone.


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