Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma: post-hoc analysis of a phase Ⅲ randomized controlled clinical trial
10.3760/cma.j.cn113030-20200412-00179
- VernacularTitle:局部晚期头颈部鳞癌不同治疗方法的Ⅲ期随机对照研究再分析
- Author:
Kai WANG
1
;
Yuan QU
;
Junlin YI
;
Xuesong CHEN
;
Xiaolei WANG
;
Shaoyan LIU
;
Zhengang XU
;
Shiping ZHANG
;
Runye WU
;
Ye ZHANG
;
Suyan LI
;
Jingwei LUO
;
Jianping XIAO
;
Li GAO
;
Guozhen XU
;
Yexiong LI
;
Xiaodong HUANG
Author Information
1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021
- From:
Chinese Journal of Radiation Oncology
2020;29(7):502-507
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.
