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Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis
Author(s) -
Stokes William A.,
Amini Arya,
Jones Bernard L.,
McDermott Jessica D.,
Raben David,
Ghosh Debashis,
Goddard Julie A.,
Bowles Daniel W.,
Karam Sana D.
Publication year - 2017
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24739
Subject(s) - medicine , induction chemotherapy , hazard ratio , head and neck cancer , cohort , chemotherapy , oncology , cancer , odds ratio , multivariate analysis , cohort study , confidence interval , surgery
Background Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. Methods 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. Results On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88–1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort ( p < .01). Conclusion Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113–1121, 2017