Elsevier

Radiotherapy and Oncology

Volume 53, Issue 2, 1 November 1999, Pages 119-125
Radiotherapy and Oncology

Prognostic impact of total tumor volume and hemoglobin concentration on the outcome of patients with advanced head and neck cancer after concomitant boost radiochemotherapy

https://doi.org/10.1016/S0167-8140(99)00119-XGet rights and content

Abstract

Purpose: To identify prognostic clinical and treatment related factors for local control, distant metastasis-free survival, and survival by means of a multivariate analysis in patients with advanced squamous cell carcinoma of the head and neck after concomitant boost radiochemotherapy.

Patients and methods: From 1992 to 1995, 68 patients with squamous cell cancer of the head and neck (93% stage IV disease) were treated with a simultaneous radiochemotherapy with Carboplatin using a concomitant boost technique. The total tumor volume (TTV) was quantitatively determined based on computed tomography scans in 56 patients. A Cox proportional hazards regression analysis was performed for each of the above endpoints and statistical significance of the Cox models was verified using the likelihood ratio test and Bonferroni correction for multiple testing.

Results: The survival and locoregional control rates at three years were 35 and 32%. The multivariate analysis revealed a significant association between the TTV and survival (P=0.0008) and between the pretreatment serum hemoglobin concentration and locoregional control (P=0.01) and survival (P=0.05). The locoregional control was significantly associated with the N-stage (P=0.007) and there was a good correlation between the N-stage and TTV in this study population.

Conclusion: Our data corroborate the prognostic relevance of the tumor volume and hemoglobin concentration. In studies comparing the survival of patients with advanced cancer of the head and neck, the use of the TTV as a covariable may improve the statistical power.

Introduction

Radiobiological considerations have led to the development of alternative fractionation regimens which are currently evaluated in clinical research. In particular for head and neck cancer, accelerated radiotherapy regimen have been suggested to overcome the accelerated repopulation of tumor cells. It has still to be determined to what extent the therapeutic index can be improved by the different protocols. The knowledge of prognostic factors is highly valuable to select patients for standard or alternative therapy, for the planning of clinical trials, development of new treatment strategies, and for the analysis of the outcome of treatment.

This study attempts to identify by means of a multivariate analysis the patient and treatment related factors most significantly associated with survival, local control, and distant metastasis-free survival in 68 patients with advanced squamous cell cancer of the head and neck who were treated with a concomitant boost radiochemotherapy as part of a prospective non-randomized multicentre study at the University of Heidelberg.

Section snippets

Patient population

From 1992 to 1995, in Heidelberg 68 patients head and neck cancer were treated with an accelerated simultaneous radiochemotherapy with Carboplatin using a concomitant boost technique as part of a prospective non-randomized, multicentre Phase II trial [18]. All patients were classified to be inoperable because of the advanced stage of the disease, other medical reasons (n=2) or refusal of a laryngectomy by the patient (n=1). Not included in the 68 patients were three patients who discontinued

General treatment outcome

The patient and treatment characteristics are shown in Table 1. All patients were treated under the same hospital conditions and received the same standardized supportive care.

The locoregional control and survival rates at three years were 32% (95% confidence interval, 0.24–0.47) and 35% (95% confidence interval, 0.24–0.47). The median follow-up time was 21 months (range: 2.5–81 months).

Distant metastases were detected in 30 (44%) patients. The location of the metastases were lung (18

Discussion

The prognostic relevance of the tumor volume and hemoglobin concentration on patients with advanced cancer of the head and neck has been confirmed by this exploratory analysis.

The strongest association was found between the TTV and survival (multivariate analysis, P=0.0003, hazard ratio 3.0). The locoregional control was significantly associated with the N-stage. Because there was a good correlation between the N-stage and TTV in this study population (Spearman's rank correlation test; R=0.45; P

References (18)

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