Abstract 674P
Background
The initial curative standard therapy for LAHNSCC by exclusive CRT or surgery (+/- CRT) have similar results in term of PFS and OS. Indication depends on several factors including regional expertise and anticipated sequela. The role of induction chemotherapy (IC) remains questionable until today. Previous publications suggested that surgery followed by CRT could be relevant for high-risk relapse tumors. The aim of this retrospective study was to compare as first-intent curative treatment CRT to alternative approach (S/IC: surgery and/or IC +/- CRT).
Methods
977 patients (pts) evaluable with a LAHNSCC treated for the first time in 1998, 2004 or 2006 were retrospectively analyzed. Pts were distributed according to their first curative treatment: CRT or S/IC. Overall (OS) and progression-free survival (PFS) from diagnosis were compared using Kaplan-Meier analyses and adjusted for stage T, stage N and age at diagnosis.
Results
Pts and treatments are summarized in the table. With a median follow-up of 3.3 years (95% IC 3.0-3.6), 335 pts died. The estimated median PFS and OS were 4.0 (95% IC 3.2-4.7) and 7.5 (95% IC 3.0-3.6) respectively in the whole population. A statistically significant lower PFS (HR = 1.26; CI95% [1.01-1.59]; p=0.0439) and lower OS (HR = 1.50; CI95% [1.16-1.95]; p=0.0023) were observed with CRT group compared to S/IC group. Weekly and tri-weekly cisplatin received as potentiation of RT were also explored in the subgroup of 346 pts (35%) receiving platin; no difference in PFS or OS were observed but statistical power is weak.
Conclusions
This large retrospective study suggests that the standard CRT for LASCCHN could be optimize by adding initial surgery or/and IC. Randomized trails are warranted to conclude. Table: 674P
| CRT Exclusive (chemo)radiation N=238 | S/IC surgery and/or induction +/- CRT N=739 | |
| Median age at diagnosis | 62.6 (38.0 - 90.8) | 58.6 (21.6 - 91.7) |
| Stage Missing data I-II III IV | 15 67 (30%) 49 (22%) 107 (48%) | 16 254 (35%) 183 (25%) 286 (40%) |
| IC No Yes | 238 (100.0%) 0 (0.0%) | 521 (70.5%) 218 (29.5%) |
| Surgery of the primary tumor No Yes | 238 (100.0%) 0 (0.0%) | 151 (20.4%) 588 (79.6%) |
| RT No Yes | 0 (0.0%) 238 (100%) | (after IC or surgery) 239 (32.3%) 500 (67.7%) |
| Potentiation of RT Missing data No Yes Whom cisplatin Missing data Weekly Tri-Weekly | 239 392 (53.1%) 346 (46.9%) 146 76 (38.0%) 124 (62.0%) |
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Centre de lutte contre le cancer Léon-Bérard.
Disclosure
J. Fayette: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, MSD, Innate Pharma, Merck Serono, Roche; Financial Interests, Institutional, Other, research funding: Seagen; Non-Financial Interests, Principal Investigator: AstraZeneca. I.L. Ray-Coquard: Financial Interests, Personal, Advisory Board: Roche, GSK, AstraZeneca, Mersana, Deciphera, Amgen, Oxnea, Merck Sereno, Agenus, Novartis, Macrogenics, Clovis; Financial Interests, Institutional, Other, Colibri Translational Research: BMS; Financial Interests, Institutional, Advisory Board, translational research Neoprembrov trial: MSD; Non-Financial Interests, Principal Investigator: PAOLA1. All other authors have declared no conflicts of interest.