Very accelerated radiotherapy or concurrent chemoradiotherapy for N3 head and neck squamous cell carcinoma: Pooled analysis of two GORTEC randomized trials. (August 2017) - Tao, Yungan
Highlights: Outcome of N3 head and neck cancer within two GORTEC phase III trials was analyzed. 5-year overall survival was 13.8% and worse for T3-4. No difference between concurrent chemoradiotherapy vs very accelerated radiotherapy. Oropharyngeal subsite presented high risk of metastasis. We observed significant interaction between treatment and subsite. Abstract: Objective: To analyze the outcome of N3 patients treated with very accelerated radiotherapy (VART) or different schedules of concurrent chemoradiotherapy (CRT) within two phase III trials. Patients and methods: Data of 179 patients with N3 HNSCC from two GORTEC randomized trials (96-01 and 99-02) were pooled. Patients received either VART: 64.8 Gy/3.5 weeks or one of the 3 following CRT regimens: Conventional CRT: 70 Gy/7 weeks + 3 cycles carboplatin-5FU; Moderately accelerated CRT: 70 Gy/6 weeks + 2 cycles carboplatin-5FU; Strongly intensified CRT: 64 Gy/5 weeks + cisplatin (days 2, 16, 30) and 5 FU (days 1–5, 29–33) followed by 2 cycles adjuvant cisplatin-5FU. Results: Median follow-up was 13.3 and 5.2 years for GORTEC 96-01 and GORTEC 99-02, respectively. Five-year overall survival (OS) was 13.8%. No significant difference was observed between CRT versus VART in terms of OS (hazard ratio [HR]: 0.93, p = 0.68), loco-regional progression (HR: 0.70, p = 0.13), or distant progression (HR: 0.86, p = 0.53). OS was worse for patients with T3-4 tumors versus early T stage (11.0% versus 25.7%, p = 0.015). In multivariate analysis, the oropharyngeal subsite presented a higher risk of distant metastasis (as first event 46.5% vs 19.2%, p < 0.001), ). A significant interaction between treatment modalities and subsites has been observed concerning loco-regional and distant failures. Conclusion: The outcome of N3 HNSCC was extremely poor despite treatment intensification and no difference between CRT and VART. Both distant metastases and loco-regional failures remain important treatment challenge.