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Comorbidity and nutritional factors influence on bioradiotherapy (BRT) outcome in head and neck squamous cell carcinoma (HNSCC) patients

Date

09 Oct 2016

Session

Poster display

Presenters

Marc Oliva

Citation

Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376

Authors

M. Oliva1, M. Taberna1, A.J. Rullan Iriarte1, M. Bergamino1, A. Rovira2, R. Montal1, L. Hurtos3, L. Arribas3, E. Vilajosana4, A. Lozano5, V. Navarro6, S. Vazquez1, M. Maños2, R. Mesía1

Author affiliations

  • 1 Medical Oncology - Head And Neck, Institut Catala de Oncologia, 08907 - Barcelona/ES
  • 2 Ent Specialist, Hospital Universitari de Bellvitge, 08097 - Barcelona/ES
  • 3 Nutrition Dpt - Head And Neck, Institut Catala de Oncologia, 08907 - Barcelona/ES
  • 4 Nursing - Head And Neck Dept., Institut Catala de Oncologia, 08907 - Barcelona/ES
  • 5 Radiation Oncology - Head And Neck, Institut Catala de Oncologia, 08907 - Barcelona/ES
  • 6 Biostatistics For Medical Oncology, Institut Catala de Oncologia, 08907 - Barcelona/ES
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Background

BRT is a validated conservative treatment for patients (pts) with locally advanced HNSCC. Our aim is to analyze the outcome of a large consecutive cohort of pts treated with radiotherapy plus cetuximab and to determine disease control and survival related factors.

Methods

253 pts diagnosed with HNSCC were treated radically with BRT +/- induction chemotherapy (iCT) in our Institution (2006-2014). We performed a multivariate analysis (COX) adjusted by classic risk factors, stage, iCT, comorbidity, weight loss (WL), pre-treatment albumin (PTA), albumin drop (AD) and magnesium (Mg). Pts were divided in 3 groups: A1(stage III), A2 (stage IVa-b), B(presence of comorbidity regardless stage). We analyzed complete response rate (CRR), 2-year locorregional control rate (2yLCR), median progression free survival (mPFS) and median overall survival (mOS) using Kaplan-Meier stratified by iCT.

Results

Median follow-up: 60 months (m) (11-115). Overall results: CRR: 76,4 %, 2yLCR: 72%, mPFS 31 m (24.7-38.5), mOS 45 m (29-61.7), iCT LogRank .00. Group results on table1: comorbidity impact on OS in group B was mantained when stratified by stage. Multivariate analysis: comorbidity and stage IV were the main risk factors for PFS (HR 2,43, p .00; HR 2,76, p .00 respectively) and OS (HR 3,05, p .00; HR 2,28, p .00 respectively). iCT influenced positively on OS (HR 0.58, p .02). WL and PTA didn't impact on PFS/OS. AD >10% during treatment was a risk factor for OS (35m vs 85m, HR 2 p .02) and influenced on 2yLCR (regression tree - 3 clusters: AD 2,21% and PTA 15% impacted on OS (18.8m vs 85.5m, HR 3.65 p .002).

Groups stratified results

A1 26 (10.3%) A2 97 (38.3%) B 130 (51.4%) Stage III:12,3% Stage IVa,b: 39,1%
CRR (%) 84 72,9 77,7
2-year LCR (%) 95 82 57,1
mPFS (m) Not Reached (NR) NR 17,8 (IC 11,9-22,5 p: .000)
mOS (m) NR NR 32 (IC 25.4-40.3, p .004)

Conclusions

Comorbidity and stage IV are the main prognostic factors in this group of pts. As it clearly impacts on survival, comorbidity should be considered when choosing the best treatment. AD at the end of treatment could be a useful prognostic biomarker. Detecting Mg drop and starting supplementation might be essential in pts treated with BRT.

Clinical trial identification

Legal entity responsible for the study

Institut Català d'Oncologia - Hospita Duran i Reynals.

Funding

Institut Català d'Oncologia - Hospita Duran i Reynals

Disclosure

M. Taberna: the author has taken part in advisory broads as a speaker for Merck Serono Group. R. Mesía: has taken part in advisory boards and educational meetings as faculty and speaker for Merck Serono, Bayer and AstraZeneca, he has also received occasional travel fund to conferences/symposia/ meetings by Merck Serono. All other authors have declared no conflicts of interest.

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