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Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout
Author(s) -
Jacobi Christian,
Gahleitner Constanze,
Bier Henning,
Knopf Andreas
Publication year - 2019
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.25796
Subject(s) - medicine , proportional hazards model , head and neck squamous cell carcinoma , hazard ratio , log rank test , oncology , stage (stratigraphy) , exact test , carcinoma , survival analysis , head and neck cancer , surgery , radiation therapy , confidence interval , paleontology , biology
Background Carotid blowout syndrome (CBS) is a rare but life‐threatening complication of head and neck squamous cell carcinoma (HNSCC). Chemoradiation (CRT) may make CBS more likely, but so far no longitudinal analysis of different treatment strategies has been conducted. Methods In the present study, 1072 patients with HNSCC were divided into groups depending on whether they had experienced CBS. Disease‐related data were analyzed using chi‐square test, Fisher exact test, and Student's t test. Survival rates were calculated using Kaplan‐Meier test, log‐rank test, and the Cox regression analysis for forward selection. Results Thirty‐six patients suffering from CBS demonstrated significantly advanced T status ( P = .001) and UICC stage ( P = .004) when compared with unaltered counterparts. After adjustment for UICC stage, OS was comparable in both groups, whereas the mean recurrence‐free survival (RFS) rate was better in unaltered patients (67 vs 24 months; P < .0001). Cox regression for forward selection revealed local recurrence (hazard ratio [HR], 1.9; P < .0001), T status (HR, 1.9; P = .03), and CRT (HR, 2.0; P < .0001) as independent risk factors for mortality related to CBS. Conclusion CBS is a rare event in patients with HNSCC demonstrating reduced OS/RFS. Advanced T status, C/RT, and the recurrence of local tumors increase the risk of CBS‐associated death.