Strahlentherapie und Onkologie

, Volume 187, Issue 5, pp 292–299

Adjuvant Low Single Dose Cisplatin-based Concurrent Radiochemotherapy of Oral Cavity and Oropharynx Carcinoma

Impact of Extracapsular Nodal Spread on Distant Metastases
  • Thomas Kuhnt
  • Ulf Klockenbrink
  • Stephan Knipping
  • Juergen Lautermann
  • Karen Kriese
  • Andreas Wienke
  • Guido Hildebrandt
  • Steffen Hauptmann
Original Article

Abstract

Background:

The aim of this study was to analyze the prognostic importance of extracapsular nodal spread (ECS) in patients with locally advanced squamous cell carcinoma (SCC) of the oral cavity or oropharynx, and the impact of adjuvant low single dose cisplatin-based radiochemotherapy on distant metastases-free survival (DMFS).

Patients and Methods:

The study population was selected from 195 patients with high-risk oral cavity or oropharyngeal cancer, who had either adjuvant radiotherapy (RT) or radiochemotherapy (RCT) between January 1, 1997 and December 31, 2006, at the University Clinic of Radiation Oncology of the Martin-Luther-University Halle-Wittenberg. A total of 42 matched pairs of patients with UICC stage III–IVa,b disease were analyzed. The patients were matched (one to one) according to tumor site, sex, T stage, N stage, ECS, resection margin status, and Karnofsky performance status. To analyze the correlation between the treatment modality (RT vs. RCT) and the impact of ECS on DMFS, the Cox proportional hazard model was used. Survival rates were calculated using the Kaplan–Meier method.

Results:

There was a strong correlation between the degree of nodal involvement and ECS (pN1: 33%; pN2b: 45%; pN2c: 71%). Moreover, the 5-year locoregional control rates (LC) in patients with ECS were 76% vs. 63% (n.s.) for RT and RCT, respectively. However, for patients without ECS, the LC was more favorable after RCT (RT vs. RCT: 62% vs. 88%, p < 0.05). DMFS again was better after RT, and this observation was independent of the presence or absence of ECS. Finally, in multivariate analyses, the presence of ECS significantly decreased the DMFS (p = 0.04, hazard ratio (HR) 2.64).

Conclusions:

Patients with ECS have an increased risk of distant metastases. Adjuvant low single dose cisplatin-based concurrent chemotherapy seems to have no influence on occult microscopic systemic disease.

Key Words

Locally advanced SCCHN Radiotherapy Radiochemotherapy Extracapsular nodal spread Distant metastases Outcome 

Adjuvante, niedrig-einzeldosierte, Cisplatin-haltige simultane Radiochemotherapie von Mundhöhlen- und Oropharynxtumoren: Der extrakapsuläre Lymphknotenbefall beeinflusst die Fernmetastasierung

Zusammenfassung

Hintergrund:

Ziel der Untersuchung war die Analyse der prognostischen Bedeutung der extrakapsulären Infiltration bei Lymphknotenmetastasen (extracapsular nodal spread – ECS) von Patienten mit lokal fortgeschrittenen Plattenepithelkarzinomen von Mundhöhle oder Oropharynx und des Einflusses der adjuvanten, niedrig-einzeldosierten Cisplatin-haltigen Radio-chemotherapie auf das fernmetastasenfreie Überleben (DMFS).

Patienten und Methodik:

Insgesamt wurden 195 Patienten ausgewertet, die an der Universitätsklinik für Strahlentherapie der Martin-Luther-Universität Halle-Wittenberg zwischen dem 1. Januar 1997 und dem 31. Dezember 2006 wegen eines Hochrisiko-Kopf-Hals-Karzinoms der Mundhöhle oder des Oropharynx postoperativ eine alleinige Radiotherapie (RT) oder eine simultane Radiochemotherapie (RCT) erhielten. Für die Analyse wurden dann 42 aufeinander abgestimmte Patientenpaare ausgewählt. Die Patienten der beiden Gruppen wurden eins zu eins gemäß Primärlokalisation, Geschlecht, T-Stadium, N-Stadium, ECS, Resektionsrand und Karnofsky-Performance-Status homogen verteilt. Die Analyse des Zusammenhangs zwischen der Behandlungsmodalität (RT vs. RCT) und dem Einfluss des ECS auf das Überleben erfolgte mit dem Cox-Regressions-Modell. Die Überlebenskurven wurden mit der Kaplan-Meier-Methode berechnet.

Ergebnisse:

Die Häufigkeit der extrakapsulären Weichgewebeinfiltration korrelierte mit dem Ausmaß der Lymphknoten-metastasierung (pN1: 33%; pN2b: 45%; pN2c: 71%). Die lokoregionale 5-Jahres-Kontrolle für Patienten mit ECS war nach RT vs. RCT: 76% vs. 63% (n.s.), während bei Patienten ohne ECS nach RCT bessere Ergebnisse erzielt wurden als nach RT (RT vs. RCT: 62% vs. 88%, p < 0,05). Das DMFS war ebenfalls besser nach RT im Vergleich zur RCT, unabhängig davon, ob ein ECS vorlag oder nicht. In der multivariaten Analyse war der Nachweis einer ECS mit einem signifikant schlechteren fernmetastasenfreien Überleben vergesellschaftet (p = 0.04, Hazard Ratio [HR] 2.64).

Schlussfolgerung:

Patienten mit ECS haben ein erhöhtes Risiko für Fernmetastasen. Die adjuvante, niedrig dosierte Cisplatin-basierte simultane Chemotherapie hatte keinen Einfluss auf die okkulte mikroskopische systemische Metastasierung.

Schlüsselwörter

Lokal fortgeschrittene Plattenepithelkarzinome Kopf-Hals-Bereich Radiotherapie Radiochemotherapie Extrakapsulärer Lymphknotenbefall Fernmetastasierung Überleben 

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Copyright information

© Urban &amp; Vogel, Muenchen 2011

Authors and Affiliations

  • Thomas Kuhnt
    • 1
    • 6
  • Ulf Klockenbrink
    • 1
  • Stephan Knipping
    • 2
  • Juergen Lautermann
    • 3
  • Karen Kriese
    • 4
  • Andreas Wienke
    • 5
  • Guido Hildebrandt
    • 1
  • Steffen Hauptmann
    • 4
  1. 1.Department of Radiation OncologyUniversity Hospital of RostockRostockGermany
  2. 2.Department of OtorhinolaryngologyHead and Neck Surgery, Städtisches Klinikum DessauDessauGermany
  3. 3.Department of OtorhinolaryngologyHead and Neck Surgery, Hospital Martha-MariaHalle-DoelauGermany
  4. 4.Institute of PathologyMartin-Luther-University Halle-WittenbergHalle (Saale)Germany
  5. 5.Institute of Medical EpidemiologyBiostatistics and Informatics, Martin-Luther-University Halle-WittenbergHalle (Saale)Germany
  6. 6.Department of Radiation OncologyUniversity RostockRostockGermany

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