Results of concurrent radio-chemotherapy for the treatment of head and neck squamous cell carcinoma in everyday clinical practice with special reference to early mortality

Abstract

Background: Randomized controlled trials have established concurrent chemo-radiotherapy as the preferred treatment option for inoperable local-regionally advanced head and neck squamous cell carcinomas (HNSCCs). Because many patients have multiple co-morbidities and would not fulfill the eligibility criteria of clinical trials, the results need to be re-evaluated in daily clinical practice with special reference to early mortality.

Methods: 167 consecutive patients with HNSCC who received concurrent chemo-radiotherapy at the Basel University Hospital between 1988 and 2006 were analyzed retrospectively with a special focus on early deaths and risk factors for an unfavorable outcome.

Results: In our cohort, the 3- and 5-year overall survival rates were 54% and 47%, respectively. The therapy was associated with relevant toxicity and an early mortality rate of 5.4%. Patients dying early were analyzed individually for the cause of death. Patients with elevated white blood cell counts (HR: 2.66 p=0,016) and vascular co-morbidities (HR: 5.3, p=0,047) showed significantly worse survival rates. The same factors were associated with a trend toward increased treatment-related mortality. The 3-year survival rate improved from approximately 43% for patients treated before the year 2000 to 65% for patients treated after the year 2000 (Fisher's exact test p=0.01).

Conclusions: Although many patients who received concurrent chemo-radiotherapy would not have qualified for clinical trials, the outcome was favorable and has significantly improved in recent years. However the early mortality was slightly worse than what is described in the literature.

Figure 1

Kaplan-Meier plots of overall-survival estimates. (a) All patients treated with concurrent chemo-radiotherapy at the Head and Neck Cancer Center of the Basel University Hospital. The 95% confidence interval is indicated by dotted lines (b). The patients treated after the year 2000 (n = 72) showed an improved survival rate with a hazard ratio of 0.526 (p = 0.0041) compared to the patients treated before the year 2000 (n = 85).

Figure 2

The prognostic impact of hemoglobin levels, leukocyte counts, albumin levels, vascular co-morbidities and alcohol consumption. The patient overall survival depends on (a) hemoglobin levels (HR 1.53; p = 0.25), (b) leukocyte counts (HR 2.26; P = 0.016), (c) pre-therapeutic albumin levels (HR 2.28; p = 0.082), (d) vascular risk factors (HR 5.3; p = 0.047) and (e) alcohol consumption (HR 1.25; p = 0.32).