Decrease in treatment intensity predicts worse outcome in patients with locally advanced head and neck squamous cell carcinoma undergoing radiochemotherapy
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S. Mollnar [1] ; P. Pondorfer [1] ; A.-K. Kasparek [1] ; S. Reinisch [1] ; F. Moik [1] ; M. Stotz [1] ; M. Halm [1] ; J. Szkandera [1] ; A. Terbuch [1] ; F. Eisner [1] ; A. Gerger [1] ; K. S. Kapp [1] ; R. Partl [1] ; S. Vasicek [1] ; T. Weiland [1] ; M. Pichler [1] ; H. Stöger [1] ; D. Thurnher [1] ; F. Posch [1]
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[1] Medical University of Graz
Medical University of Graz
Graz, Austria
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- Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 23, Nº. 3 (March), 2021, págs. 543-553
- Idioma: inglés
- Texto completo no disponible (Saber más ...)
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Resumen
Purpose Radiochemotherapy (RCT) is an effective standard therapy for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Nonetheless, toxicity is common, with patients often requiring dose modifications.
Methods To investigate associations of RCT toxicities according to CTCAE version 5.0 and subsequent therapy modifications with short- and long-term treatment outcomes, we studied all 193 patients with HNSCC who received RCT (70 Gy + platinum agent) at an academic center between 03/2010 and 04/2018.
Results During RCT, 77 (41%, 95% CI 34–49) patients developed at least one ≥ grade 3 toxicity, including seven grade 4 and 3 fatal grade 5 toxicities. The most frequent any-grade toxicities were xerostomia (n = 187), stomatitis (n = 181), dermatitis (n = 174), and leucopenia (n = 98). Eleven patients (6%) had their radiotherapy schedule modified (mean radiotherapy dose reduction = 12 Gy), and 120 patients (64%) had chemotherapy modifications (permanent discontinuation: n = 67, pause: n = 34, dose reduction: n = 7, change to other chemotherapy: n = 10). Objective response rates to RCT were 55% and 88% in patients with and without radiotherapy modifications (p = 0.003), and 84% and 88% in patients with and without chemotherapy modifications (p = 0.468), respectively. Five-year progression-free survival estimates were 20% and 50% in patients with and without radiotherapy modifications (p = < 0.001), and 53% and 40% in patients with and without chemotherapy modifications (p = 0.88), respectively.
Conclusions Reductions of radiotherapy dose were associated with impaired long-term outcomes, whereas reductions in chemotherapy intensity were not. This suggests that toxicities during RCT should be primarily managed by modifying chemotherapy rather than radiotherapy.
