Einfluss höhergradiger akuter Organtoxizität während adjuvanter Radio(chemo)therapie auf die Prognose von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren

Eine retrospektive Analyse

High-grade acute organ toxicity as positive prognostic factor in adjuvant radio(chemo)therapy for locally advanced head and neck cancer

by Benjamin Daldrup
Doctoral thesis
Date of Examination:2013-05-15
Date of issue:2013-05-14
Advisor:Prof. Dr. Hans Christiansen
Referee:Prof. Dr. Christian Hommerich
Referee:Prof. Dr. Dr. Thomas Crozier
Persistent Address: http://dx.doi.org/10.53846/goediss-3843

 

 

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Abstract

English

Purpose: To test for an association between high-grade acute organ toxicity during adjuvant radio(chemo)therapy (R(C)T) and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Material and Methods: Institutional review board approval was obtained for this retrospective tudy. From 09/1994-10/2008, 294 HNSCC patients were treated with adjuvant R(C)T at our department. They received normofractionated (2Gy/fraction) irradiation to include associated nodal drainage sites for a cumulative dose of 60-64Gy. From 01/2002 until 12/2009, 91 patients received additional concomitant cisplatin-based chemotherapy. Toxicity during treatment was monitored weekly according to the common-toxicity-criteria (CTC);any toxicity grade CTC≥3, including mucositis, dysphagia or skin reaction, was considered high-grade acute organ toxicity. The influence of possible prognostic factors on overall survival and loco-regional control was studied by uni- and multivariate Cox regression. Results: We found a statistically significant association between high-grade acute organ toxicity and both overall survival as well as loco-regional control. Patients with CTC≥3 acute organ toxicity had a 5-year-overall-survival and loco-regional-control rate of 90% and 97%, respectively, as compared to 24% and 74% in patients without such toxicity (p<0.01). Multivariate analyses revealed that this association was independent from other factors that may influence treatment toxicity, especially concomitant chemotherapy and/or radiotherapy. Conclusion: Our data suggest that normal tissue and tumour tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during R(C)T was associated with better outcomes in our patient population. Therefore, the hypothesis should be further analyzed on the biomolecular and clinical level and other tumor entities in prospective clinical trials.
Keywords: adjuvant radio(chemo)therapy, head and neck cancer
 
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