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Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis
Author(s) -
Kirke Dia.,
Qureshi Muhammad M.,
Kamran Sophia C.,
Ezzat Waleed,
Jalisi Scharukh,
Salama Andrew,
Everett Peter C.,
Truong Minh Tam
Publication year - 2018
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.25087
Subject(s) - adjuvant , medicine , head and neck squamous cell carcinoma , hazard ratio , oncology , chemoradiotherapy , head and neck cancer , stage (stratigraphy) , cancer , adjuvant radiotherapy , multivariate analysis , adjuvant therapy , radiation therapy , cohort , surgery , confidence interval , paleontology , biology
Background The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC). Methods Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three‐year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. Results Median follow‐up was 41.8 months with 2193 reported deaths. The 3‐year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT ( P = .013). For negative margins, the corresponding 3‐year OS was 70.1% and 74.9% ( P = .005). For positive margins, the corresponding 3‐year OS was 56.0% and 60.6% ( P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79‐1.03; P = .124). Conclusion In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.