1056 - Treatment failure in high-risk head and neck cancer treated with adjuvant chemoradiation

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anticancer agents
Head and Neck Cancers
Surgical oncology
Therapy
Biological therapy
Radiation oncology
Presenter Sofia Torres
Authors S. Torres1, M.T. Marques1, M. Ferreira1, I. Sargento1, E. Netto1, J. Oliveira2, M. Roldão1, A. Moreira1
  • 1Medical Oncology, Instituto Portuguès de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), 1099-023 - Lisboa/PT
  • 2Oncology, Instituto Portuguès de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), 1099-023 - Lisboa/PT

Abstract

Background

Adjuvant chemoradiation (adCRT) is the standard of care in resectable high-risk head and neck squamous cell carcinoma (HNSCC). We select patients (pts) for adCRT if they are physically fit and have at least 1 major (extra-capsular nodal spread or positive resection margins) and/or 2 minor (pT4, pN2, perineural or vascular invasion) high risk pathological factors. Loco-regional control and disease-free survival (DFS) are good and the toxicities manageable. The aim of our study was to evaluate the patterns of treatment (tt) failure with this therapy.

Methods

We reviewed the charts of all pts with resected high-risk HNSCC treated with adCRT, from 2007 to 2011. Pts and disease characteristics, compliance to tt, date and first site of tt failure and disease status at last follow-up (FU) were reviewed. Overall survival (OS) and DFS were estimated using Kaplan-Meier method.

Results

221 consecutive pts were included, 93.6% male, median age 52 years. The incidence of stage IVA−B disease (72.8%) and major high risk pathological features such as involved surgical margins (50.6%) and extranodal spread of the disease (52.0%) was high. Compliance to tt was good with 94.5% of pts completing at least 2 cycles of chemotherapy. There were no toxic deaths. With a median FU of 18.8 months, 57 pts (25.8%) experienced disease recurrence. Local or regional recurrence as the first site of tt failure occurred in 25 pts (11.3%) and distant metastasis (mets) occurred in 32 pts (14.5%). The most common site of metastatic disease was the lung (26 pts; 11.7%). Lung recurrence occurred at a median FU of 8 months. Nine pts (4%) recurred with lung mets less than 6 months after the end of adCRT. Five pts were diagnosed of primary lung cancer during FU. At last FU 175 pts (79.2%) were alive; 154 (69.9%) in complete remission. The Kaplan-Meier estimates of 3-year OS and DFS were 68% and 59%, respectively.

Conclusions

Through adequate selection of pts and supportive measures, high tt compliance and manageable toxicity of adCRT are achieved. The observed early recurrence in a small number of pts, mainly in the lung, might suggest that more detailed pretreatment staging and FU evaluation for early lung disease detection are warranted.

Disclosure

All authors have declared no conflicts of interest.