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Impact of race on outcome after definitive radiotherapy for squamous cell carcinoma of the head and neck
Author(s) -
AlOthman Majid O. F.,
Morris Christopher G.,
Logan Henrietta L.,
Hinerman Russell W.,
Amdur Robert J.,
Mendenhall William M.
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11822
Subject(s) - medicine , radiation therapy , neck dissection , head and neck cancer , head and neck squamous cell carcinoma , chemotherapy , surgery , carcinoma , distant metastasis , cancer , oncology , metastasis
BACKGROUND The objective of the current study was to evaluate the impact of race (black vs. white) on the outcome of patients with invasive squamous cell carcinoma of the head and neck. METHODS Between 1983 and 1997, 686 patients completed definitive, twice‐daily radiotherapy (RT) alone or combined with a planned neck dissection; no patients received adjuvant chemotherapy. The minimum follow‐up was 2 years, and median follow‐up was 7 years for living patients. No patients were lost to follow‐up. Fifty‐five patients were black (8%). RESULTS Although the two groups had similar 5‐year local‐regional control rates (black patients vs. white patients: 70% vs. 76%, respectively; P = 0.275), black patients had double the risk for distant recurrence compared with white patients (27% vs. 13%; P = 0.012). The 5‐year cause‐specific and absolute survival rates were lower for black patients (52% vs. 74% [ P = 0.001] and 29% vs. 52% [ P < 0.001], respectively). Multivariate analyses revealed that race was an independent predictor of freedom from distant metastasis ( P = 0.013), cause‐specific survival ( P = 0.005), and absolute survival ( P < 0.001). CONCLUSIONS Although equal local‐regional control rates can be achieved in black patients and white patients with squamous cell carcinoma of the head and neck, the risk of distant recurrence was significantly higher in black patients and resulted in decreased survival. Reevaluation of current strategies for pretreatment metastatic work‐ups and development of more effective systemic therapy will be key to improving the survival disparity in this group. Cancer 2003. © 2003 American Cancer Society.