Induction Chemotherapy as a Prognostication Index and Guidance for Treatment of Locally Advanced Head and Neck Squamous Cell Carcinoma: The Concept of Chemo-Selection (KCSG HN13-01)
- Author:
Yun-Gyoo LEE
1
;
Eun Joo KANG
;
Bhumsuk KEAM
;
Jin-Hyuk CHOI
;
Jin-Soo KIM
;
Keon Uk PARK
;
Kyoung Eun LEE
;
Hyo Jung KIM
;
Keun-Wook LEE
;
Min Kyoung KIM
;
Hee Kyung AHN
;
Seong Hoon SHIN
;
Hye Ryun KIM
;
Sung-Bae KIM
;
Hwan Jung YUN
Author Information
- Publication Type:Original Article
- From:Cancer Research and Treatment 2022;54(1):109-117
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Certain patient subgroups who do not respond to induction chemotherapy (IC) show inherent chemoresistance in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This study aimed to assess the prognostic value of IC, and role of IC in guiding the selection of a definitive locoregional therapy.
Materials and Methods:Out of the 445 patients in multi-institutional LA-HNSCC cohort, 158 (36%) receiving IC were enrolled. The study outcome was to assess overall survival (OS) through IC responsiveness and its role to select subsequent treatments.
Results:Among 135 patients who completed subsequent treatment following IC, 74% responded to IC (complete response in 17% and partial response in 58%). IC-non-responders showed 4.5 times higher risk of mortality than IC-responders (hazard ratio, 4.52; 95% confidence interval, 2.32 to 8.81; p < 0.001). Among IC-responders, 84% subsequently received definitive concurrent chemoradiotherapy (CCRT) and OS was not differed by surgery or CCRT (p=0.960). Regarding IC-non-responders, 54% received CCRT and 46% underwent surgery, and OS was poor in CCRT (24-month survival rate of 38%) or surgery (24-month survival rate of 63%).
Conclusion:Response to IC is a favorable prognostic factor. For IC-responders, either surgery or CCRT achieved similar survival probabilities. For IC-non-responder, multidisciplinary approach was warranted reflecting patients’ preference, morbidity, and prognosis.
