Skip to main content
SpringerLink
Log in

Survival of patients with head and neck cancer

Impact of physical status and comorbidities

Das Überleben von Patienten mit Kopf-Hals-Tumoren

Einfluss von körperlicher Konstitution und Begleiterkrankungen

  • Original article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Prognostic factors (e.g., gender, tumor stage, and hypoxia) have an impact on survival in patients with head and neck cancer. Thus, the impact of physical status and comorbidities on treatment decision and survival were evaluated.

Patients and methods

A total of 169 primary, inoperable patients with squamous cell cancer of the head and neck were retrospectively investigated. Patients were treated with hyperfractionated accelerated radio(chemo)therapy (HARcT) or hypofractionated radio(chemo)therapy (HypoRcT). Depending on the individual patient’s situation (Karnofsky Performance Index, KPI), treatment for patients with a KPI of 80–100% was generally radiochemotherapy and for patients with a KPI ≤ 70% treatment was radiotherapy alone. In addition, all comorbidities were evaluated. Uni- and multivariate proportional hazards model were used, and overall survival (OS) was estimated by the Kaplan–Meier method.

Results

Treatment consisted of HARcT for 76 patients (45%), HART for 28 patients (17%), HypoRcT for 14 patients(8%), and HypoRT for 51 patients (30%). Of the patients, 107 patients (63%) presented with a KPI of 80–100%. OS (20%) was significantly better for patients with a KPI of 80–100%, while the OS for patients with a KPI ≤ 70% was 8% (p < 0.001). Good KPI, total irradiation dose (> 70 Gy), and chemotherapy were significant prognostic factors for better OS.

Conclusion

Our retrospective analysis shows that performance status with dependency on comorbidities was an independent risk factor for OS.

Zusammenfassung

Hintergrund

Prognostische Faktoren wie z. B. Geschlecht, Tumorstadium und Hypoxie haben Einfluss auf das Überleben von Patienten mit Kopf-Hals-Tumoren. Wir untersuchten, ob die körperliche Konstitution und Komorbidität die Therapieentscheidung und das Überleben beeinflussen.

Patienten und Methoden

169 primär inoperable Patienten mit Plattenepithelkarzinomen im Kopf-Hals-Bereich wurden retrospektiv ausgewertet. Alle Patienten wurden entweder mit hyperfraktioniert-akzelerierter Radio(chemo)therapie (HARcT) oder hypofraktionierter Radio(chemo)therapie (HypoRcT) behandelt. Abhängig von der individuellen körperlichen Konstitution (Karnofsky Performance Index, KPI) wurde bei KPI 100–80% zumeist mit Radiochemotherapie und bei KPI  ≤ 70% häufig mit Radiotherapie allein therapiert. Zusätzlich wurden alle Komorbiditäten der Patienten erfasst. Die uni- und multivariate Cox-Regressions-Analyse wurde verwendet und das Gesamtüberleben (ÜL) mit der Kaplan-Meier-Methode berechnet.

Ergebnisse

76 Patienten (45%) wurden mit HARcT, 28 (17%) mit HART, 14 (8%) mit HypoRcT und 51 (30%) mit HypoRT behandelt. 107 Patienten (63%) waren in einem KPI 100–80%. Das ÜL bei Patienten mit KPI 100–80% war mit 20% im Vergleich zu Patienten mit KPI  ≤ 70% mit 8% (p < 0,001) besser. Sehr guter KPI, Enddosis (> 70 Gy) und simultane Chemotherapie waren unabhängige prognostische Faktoren für ein besseres ÜL.

Schlussfolgerungen

Unsere retrospektive Analyse zeigt, dass die körperliche Konstitution (KPI) in Abhängigkeit von Begleiterkrankungen ein unabhängiger, prognostischer Faktor für das Überleben der Patienten war.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Bradley JD, Ieumwananonthachai N, Purdy JA et al (2002) Gross tumor volume, critical prognostic factor in patients treated with three-dimensional conformal radiation therapy for non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 52:49–57

    Article  PubMed  Google Scholar 

  2. Budach V, Stuschke M, Budach W et al (2005) Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol 23:1125–1135

    Article  PubMed  CAS  Google Scholar 

  3. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies. J Chronc Dis 40:373–383

    Article  CAS  Google Scholar 

  4. Cleary PD, Greenfield SG, Mulley AG et al (1991) Variation in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA 266:73–79

    Article  PubMed  CAS  Google Scholar 

  5. Dietl B, Marienhagen J, Schaefer C et al (2007) Survival with distant metastatic disease in head and neck cancer. A retrospective analysis. HNO 55:788–791

    Article  Google Scholar 

  6. Dunst J, Stadler P, Becker A et al (2003) Tumor volume and tumor hypoxia in head and neck cancers. The amount of the hypoxic volume is important. Strahlenther Onkol 179:521–526

    Article  PubMed  Google Scholar 

  7. Fietkau R (2000) Tumor volume as a prognostic factor in the radiotherapy of carcinomas in the head-neck area. Strahlenther Onkol 176:382–383

    Article  PubMed  CAS  Google Scholar 

  8. Gunn GB, Endres EJ, Parker B et al (2010) A phase I/II study of altered fractionated IMRT alone for intermediate T-stage oropharyngeal carcinoma. Strahlenther Onkol 186:489–495

    Article  PubMed  Google Scholar 

  9. Hall SF, Rochon PA, Streiner DL et al (2002) Measuring comorbidity in patients with head and neck cancer. Laryngoscope 112:1988–1996

    Article  PubMed  Google Scholar 

  10. Jeremic B, Milicic B (2009) Pretreatment prognostic factors of survival in patients with locally advanced nonmetastatic squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy. Am J Clin Oncol 32:63–68

    Google Scholar 

  11. Kaplan MH, Feinstein AR (1974) The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. J Chronc Dis 27:387–404

    Article  CAS  Google Scholar 

  12. Karnofsky DA, Abelmann WH, Craver LF et al (1948) The use of nitrogen mustards in the palliative treatment of cancer. Cancer 1:634–656

    Article  Google Scholar 

  13. Kuhnt T, Janich M, Götz U et al (2006) Presentation of a 3D conformal radiotherapy technique for head-and-neck tumors resulting in substantial protection of the parotid glands. Strahlenther Onkol 182:325–330

    Article  PubMed  Google Scholar 

  14. Kuhnt T, Klockenbrink U, Knipping S et al (2011) Adjuvant low single dose cisplatin-based concurrent radiochemotherapy of oral cavity and oropharynx carcinoma: impact of extracapsular nodal spread on distant metastases. Strahlenther Onkol 187:292–299

    Article  PubMed  Google Scholar 

  15. Kuhnt T, Mueller AC, Pelz T et al (2005) Impact of tumor control and presence of visible necrosis in head and neck cancer patients treated with radiotherapy or radiochemotherapy. J Cancer Res Clin Oncol 131:758–764

    Article  PubMed  CAS  Google Scholar 

  16. Kreppel M, Drebber U, Eich HT et al (2011) Combined-modality treatment in advanced oral squamous cell carcinoma: primary surgery followed by adjuvant concomitant radiochemotherapy. Strahlenther Onkol 187:555–560

    Article  PubMed  Google Scholar 

  17. Linn BS, Linn MW, Lee G (1968) Cumulative illness rating scale. J Am Geriatr Soc 5:622–626

    Google Scholar 

  18. Paleri V, Wight RG, Silver CE et al (2010) Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. Oral Oncol 46:712–719

    Article  PubMed  Google Scholar 

  19. Rades D, Stoehr M, Meyners T et al (2008) Evaluation of prognostic factors and two radiation techniques in patients treated with surgery followed by radio(chemo)therapy or definitive radio(chemo)therapy for locally advanced head-and-neck cancer. Strahlenther Onkol 184:198–205

    Article  PubMed  Google Scholar 

  20. Ragin CC, Modugno F, Gollin SM et al (2007) The epidemiology and risk factors of head and neck cancer: a focus on human papillomavirus. J Dent Res 86:104–114

    Article  PubMed  CAS  Google Scholar 

  21. Robert Koch Institut (ed) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland (2010) Krebs in Deutschland 2005/2006. Häufigkeiten und Trends, 7. edition. Berlin

  22. Rubin P, Constine LS, Fajardo LF et al (1995) RTOG Late Effects Working Group. Overview. Late Effects of Normal Tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 31:1041–1042

    Article  PubMed  CAS  Google Scholar 

  23. Sanabria A, Carvalho AL, Vartanian JG et al (2007) Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol 14:1449–1457

    Article  PubMed  Google Scholar 

  24. Schafer U, Micke O, Mueller SB et al (2003) Hemoglobin as an independent prognostic factor in the radiotherapy of head and neck tumors. Strahlenther Onkol 179:527–534

    Article  PubMed  Google Scholar 

  25. Steinmann D, Cerny B, Karstens JH et al (2009) Chemoradiotherapy with weekly cisplatin 40 mg/m(2) in 103 head-and-neck cancer patients: a cumulative dose-effect analysis. Strahlenther Onkol 185:682–688

    Article  PubMed  Google Scholar 

  26. Studer G, Seifert B, Glanzmann C (2008) Prediction of distant metastasis in head neck cancer patients: implications for induction chemotherapy and pre-treatment staging? Strahlenther Onkol 184:580–585

    Article  PubMed  Google Scholar 

  27. Tribius S, Kronemann S, Kilic Y et al (2009) Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Strahlenther Onkol 185:675–681

    Article  PubMed  Google Scholar 

  28. VonKorff M, Wagner EH, Saunders K (1992) A chronic disease score from automated pharmacy data. J Clin Epidemiol 45:197–203

    Article  CAS  Google Scholar 

  29. Wolff HA, Bosch J, Jung K, Overbeck T et al (2010) High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer. Strahlenther Onkol 186:262–268

    Article  PubMed  Google Scholar 

  30. Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky Performance Status. Cancer 45:222–224

    Article  Google Scholar 

  31. Zubrod CG, Schneiderman M, Frei E et al (1960) Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chron Dis 11:7–33

    Article  Google Scholar 

Download references

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Clinic of Radiotherapy, Friedrich Alexander University, Erlangen, Germany

    F. Sadat

  2. Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany

    A. Wienke

  3. Clinic of Radiotherapy, University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany

    J. Dunst

  4. Department of Radiation Oncology, Clinic of Radiotherapy, University Rostock, Suedring 75, 18059, Rostock, Germany

    T. Kuhnt MD

Authors
  1. F. Sadat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Wienke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Kuhnt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Kuhnt MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sadat, F., Wienke, A., Dunst, J. et al. Survival of patients with head and neck cancer. Strahlenther Onkol 188, 62–70 (2012). https://doi.org/10.1007/s00066-011-0009-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-011-0009-8

Keywords

Schlüsselwörter

Search

Navigation