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Is there a patient population with squamous cell carcinoma of the head and neck region who might benefit from de-intensification of postoperative radiotherapy?

A monocentric retrospective analysis of a previously defined low-risk patient population treated with standard-of-care radiotherapy
  • Yonca Onbasi
  • Sebastian Lettmaier
  • Markus Hecht
  • Sabine Semrau
  • Heinrich Iro
  • Marco Kesting
  • Rainer Fietkau
  • Marlen HaderleinEmail author
Original Article
  • 67 Downloads

Abstract

Purpose

The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1–3, pN0–pN2b), hypopharynx (pT1–2, pN0–pN1), and the indication for postoperative radio(chemo)therapy.

Patients and methods

According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan–Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters.

Results

Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048).

Conclusion

Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).

Keywords

Overall survival Disease-free survival Second cancer Late side effect Radio(chemo)therapy 

Gibt es Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region, die von einer Deintensivierung der postoperativen Bestrahlung profitieren könnten?

Eine monozentrische Analyse eines definierten Niedrigrisiko-Patientenkollektivs, das mit der Standardbestrahlung therapiert wurde

Zusammenfassung

Ziel

Ziel dieser retrospektiven Studie war es, das klinische Outcome für ein ausgewähltes Niedrigrisiko-Patientenkollektiv nach stattgehabter vollständiger Resektion (R0) von Plattenepithelkarzinomen der Mundhöhle, des Oropharynx, Larynx (pT1–3, pN0–pN2b), Hypopharynx (pT1–2, pN0–pN1) und der Indikation zur postoperativen Radio(chemo)therapie zu ermitteln.

Patienten und Methoden

Nach zuvor definierten Kriterien wurden 99 Patienten mit Plattenepithelkarzinomen im Kopf-Hals-Bereich, die sich vom 1. Januar 2005 bis 31. Dezember 2014 in unserer Klinik in Behandlung befanden, in die Auswertung einbezogen. Die Kaplan-Meier-Methode kam für die Berechnung der Überlebens- und Inzidenzrate zur Anwendung. Für die univariate Analyse wurde der Log-rank-Test zur Auswertung der prognostisch relevanten Parameter verwendet.

Ergebnisse

Das mediane Follow-up betrug 67 Monate. Das kumulative Gesamtüberleben (OS) und das kumulative krankheitsfreie Überleben (DFS) beliefen sich jeweils auf 97,9 %/94,7 %/88,0 % und 96,9 %/92,6 %/84,7 % nach 1, 2 und 5 Jahren. Die kumulativen Inzidenzen für das lokoregionäre Rezidiv (LRR), Fernmetastasen (DM) und das Zweitkarzinom (SC) betrugen jeweils 1,0 %/1,0 %/4,9 %, 0,0 %/3,4 %/5,8 % und 2,1 %/4,2 %/13,1 %. In der univariaten Analyse korrelierte die Primärtumorregion Oropharynx mit einem besseren OS (p = 0,043) und DFS (p = 0,048).

Schlussfolgerung

In Anbetracht der niedrigen Rezidivraten, der hohen Spätnebenwirkungsraten und des erhöhten SC-Risikos wurde eine prospektive, multizentrische Studie initiiert, die die Deeskalation der Strahlentherapie bei diesem ausgewählten Niedrigrisiko-Patientenkollektiv untersucht und noch Patienten rekrutiert (DIREKHT-Studie, NCT02528955).

Schlüsselwörter

Gesamtüberleben Krankheitsfreies Überleben Zweitkarzinom Spätnebenwirkung Radio(chemo)therapie 

Notes

Acknowledgements

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med. dent.”. I would give my sincere thanks to my helpful mentors Dr. Marlen Haderlein and Dr. Sebastian Lettmaier for their kind support.

Conflict of interest

Y. Onbasi, S. Lettmaier, M. Hecht, S. Semrau, H. Iro, M. Kesting, R. Fietkau, and M. Haderlein declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  2. 2.Department of ProsthodonticsUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  3. 3.Department of OtorhinolaryngologyUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany
  4. 4.Department of Oral and Maxillofacial SurgeryUniversity Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenGermany

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