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Radiation Oncology

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Open Access 01-12-2012 | Research

Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors

Authors: Valentina Krstevska, Igor Stojkovski, Beti Zafirova-Ivanovska

Published in: Radiation Oncology | Issue 1/2012

Abstract

Background

Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category.

Methods

Sixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m²) started at the first day of radiotherapy.

Results

Median age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.

On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively).

Conclusions

Poor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.

Available only for authorised users

Global data on incidence of oral cancer, Oral Health Programme: World Health Organization. [http://www.who.int/oral_health/publications/oral_cancer_brochure.pdf]

Evans PHR, Patel SG, Henk JM: Tumours of the oropharynx. In Principles and Practice in Head and Neck Oncology. 2nd edition. Edited by: Evans PHR, Montgomery PQ, Gullane PJ. 2006, Taylor & Francis e-Library, London, 376-437.

Brugere J, Guenel P, Leclerc A, Rodriguez J: Differential effects of tobacco and alcohol in cancer of the larynx, pharynx, and mouth. Cancer. 1986, 57: 391-395. 10.1002/1097-0142(19860115)57:2<391::AID-CNCR2820570235>3.0.CO;2-Q.CrossRefPubMed

Ringstrom E, Peters E, Hasegawa M, Posner M, Liu M, Kelsey KT: Human papillomavirus type 16 and squamous cell carcinoma of the head and neck. Clin Cancer Res. 2002, 8: 3187-3192.PubMed

Gillison ML, D’Souza G, Westra W, Sugar E, Xiao W, Begum S, Viscidi R: Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus 16-negative head and neck cancers. J Natl Cancer Inst. 2008, 100: 407-420. 10.1093/jnci/djn025.CrossRefPubMed

Forastiere A, Koch W, Trotti A, Sidransky D: Head and neck cancer. N Engl J Med. 2001, 345: 1890-1900. 10.1056/NEJMra001375.CrossRefPubMed

Ruff T, Lenis A, Skinner OD: Carcinoma of the oral cavity and oropharynx. Surg Clin North Am. 1986, 66: 659-671.PubMed

Machtay M, Perch S, Markiewicz D, Thaler E, Chalian A, Goldberg A, Kligerman M, Weinstein G: Combined surgery and postoperataive radiotherapy for carcinoma of the base of tongue. Head Neck. 1997, 19: 494-499. 10.1002/(SICI)1097-0347(199709)19:6<494::AID-HED6>3.0.CO;2-U.CrossRefPubMed

Carvalho AL, Magrin J, Kowalski LP: Sites of recurrence in oral and oropharyngeal cancers according to the treatment approach. Oral Dis. 2003, 9: 112-118. 10.1034/j.1601-0825.2003.01750.x.CrossRefPubMed

10.

Guggenheimer J, Verbin RS, Johnson JT, Horkowitz CA, Myers EN: Factors delaying the diagnosis of oral and oropharyngeal carcinomas. Cancer. 1989, 64: 932-935. 10.1002/1097-0142(19890815)64:4<932::AID-CNCR2820640428>3.0.CO;2-Y.CrossRefPubMed

11.

Henk JM: Results of radiotherapy for carcinoma of the oropharynx. Clin Otolaryngol & Allied Sci. 1978, 3: 137-143. 10.1111/j.1365-2273.1978.tb00676.x.CrossRef

12.

Lindberg R: Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer. 1972, 29: 1446-1450. 10.1002/1097-0142(197206)29:6<1446::AID-CNCR2820290604>3.0.CO;2-C.CrossRefPubMed

13.

Browman GP, Cripps C, Hodson DI, Eapen L, Sathya J, Levine MN: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol. 1994, 12: 2648-2653.PubMed

14.

Haffty BG, Son YH, Papac R, Sasaki CT, Weissberg JB, Fischer D, Rockwell S, Sartorelli AC, Fischer JJ: Chemotherapy as an adjunct to radiation in the treatment of squamous cell carcinoma of the head and neck: Results of the Yale Mitomycin Randomized Trials. J Clin Oncol. 1997, 15: 268-276.PubMed

15.

Wendt TG, Grabenbauer GG, Rodel CM, Thiel HJ, Aydin H, Rohloff R, Wustrow TP, Iro H, Popella C, Schalhorn A: Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol. 1998, 16: 1318-1324.PubMed

16.

Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998, 338: 1798-1804. 10.1056/NEJM199806183382503.CrossRefPubMed

17.

Adelstein DJ, Lavertu P, Saxton JP, Secic M, Wood BG, Wanamaker JR, Eliachar I, Strome M, Larto MA: Mature results of a phase III randomized trial comparing chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer. 2000, 88: 876-883. 10.1002/(SICI)1097-0142(20000215)88:4<876::AID-CNCR19>3.0.CO;2-Y.CrossRefPubMed

18.

Jeremic B, Shibamoto Y, Milicic B, Nikolic N, Dagovic A, Aleksandrovic J, Vaskovic Z, Tadic L: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol. 2000, 18: 1458-1464.PubMed

19.

Pignon JP, Bourhis J, Domenge C, Designe L: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet. 2000, 355: 949-955.CrossRefPubMed

20.

Pignon JP, le Maitre A, Maillard E, Bourhis J: Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomized trials and 17,346 patients. Radiother Oncol. 2009, 92: 4-14. 10.1016/j.radonc.2009.04.014.CrossRefPubMed

21.

Browman GP, Hodson DI, Mackenzie RJ, Bestic N, Zuraw L, Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group, Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group: Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: a systematic review of the published literature with subgroup analysis. Head Neck. 2001, 23: 579-589. 10.1002/hed.1081.CrossRefPubMed

22.

Budach W, Hehr T, Budach V, Belka C, Dietz K: A Meta-Analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer. 2006, 6: 28-39. 10.1186/1471-2407-6-28.PubMedCentralCrossRefPubMed

23.

Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Bertrand P: Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst. 1999, 91: 2081-2086. 10.1093/jnci/91.24.2081.CrossRefPubMed

24.

Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G: Final results of the 94-01 French Head and Neck Oncology and Radiotherapy group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004, 22: 69-76.CrossRefPubMed

25.

Sharma A, Mohanti BK, Thakar A, Bahadur S, Bhasker S: Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: a phase II randomized trial. Ann Oncol. 2010, 21: 2272-2277. 10.1093/annonc/mdq219.CrossRefPubMed

26.

Blanchard P, Baujat B, Holostenco V, Bourredjem A, Baey C, Bourhis J, Pignon J-P, on behalf of the MACH-CH Collaborative group, on behalf of the MACH-CH Collaborative group: Meta-analysis of chemotherapy in head and neck cancer (MACH-HC: A comprehensive analysis by tumour site. Radiother Oncol. 2011, 100: 33-40. 10.1016/j.radonc.2011.05.036.CrossRefPubMed

27.

Adelstein DJ, Li Y, Adams GL, Wagner H, Kish JA, Ensley JF, Schuller DE, Forastiere AA: An intergroup phase III comparison of standard radiation and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003, 21: 92-98. 10.1200/JCO.2003.01.008.CrossRefPubMed

28.

Kurihara N, Kubota T, Hoshiya Y, Otani Y, Ando N, Kumai K, Kitajima M: Pharmacokinetics of cis-diamminedichloroplatinum (II) given as low-dose and high-dose infusions. J Surg Oncol. 1996, 62: 135-138. 10.1002/(SICI)1096-9098(199606)62:2<135::AID-JSO10>3.0.CO;2-7.CrossRefPubMed

29.

Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D’Cruz AK, Dinshaw KA: Radical radiotherapy with concurrent weekly cisplatin in locoregionally advanced squamous cell carcinoma of the head and neck: a single-institution experience. Head Neck Oncol. 2009, 1: 17-10.1186/1758-3284-1-17.PubMedCentralCrossRefPubMed

30.

Gupta D, Shukla P, Bisht SS, Dhawan A, Pant MC, Bhatt ML, Gupta S, Gupta R, Negi MPS: A prospective comparision of sequential chemoradiation vs concurrent chemoradiation in locally advanced oropharyngeal carcinomas. Cancer Biol Ther. 2009, 8: 213-217. 10.4161/cbt.8.3.7484.CrossRefPubMed

31.

Brizel DM, Esclamado R: Concurrent chemoradiotherapy for locally advanced, nonmetastatic, squamous carcinoma of the head and neck: consensus, controversy, and conundrum. J Clin Oncol. 2006, 24: 2612-2617. 10.1200/JCO.2005.05.2829.CrossRefPubMed

32.

Purdy A: Dose to normal tissues outside the radiation therapy patient's treated volume: a review of different radiation therapy techniques. Health Phys. 2008, 5: 666-676.CrossRef

33.

Chao KS, Ozyigit G, Blanco AI, Thorstad WL, Deasy JO, Haughey BH, Spector GJ, Sessions DG: Intensity-modulated radiation therapy for oropharyngeal carcinoma: impact of tumor volume. Int J Radiat Oncol Biol Phys. 2004, 59: 43-50. 10.1016/j.ijrobp.2003.08.004.CrossRefPubMed

34.

Eisbruch A, Ship JA, Dawson LA, Kim HM, Bradford CR, Terrell JE, Chepeha DB, Teknos TN, Hogikyan ND, Anzai Y, Marsh LH, Ten Haken RK, Wolf GT: Salivary gland sparing and improved target irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg. 2003, 27: 832-837. 10.1007/s00268-003-7105-6.CrossRefPubMed

35.

Studer G, Huguenin PU, Davis JB, Kunz G, Lutolf UM, Glanzmann C: IMRT using simultaneously integrated boost (SIB) in head and neck patients. Radiat Oncol. 2006, 1: 7-21. 10.1186/1748-717X-1-7.PubMedCentralCrossRefPubMed

36.

de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, Stambuk H, Pfister D, Kraus D, Shaha A, Shah J, Lee NY: Intensity modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 2005, 64: 363-373.CrossRefPubMed

37.

Huang K, Xia P, Chuang C, Weinberg V, Glastonbury CM, Eisele DW, Lee NY, Yom SS, Phillips TL, Quivey JM: Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: the University of California-San Francisco experience. Cancer. 2008, 113: 497-507. 10.1002/cncr.23578.CrossRefPubMed

38.

Feng FY, Kim HM, Lyden TH, Haxer MJ, Worden FP, Feng M, Moyer JS, Prince ME, Carey TE, Wolf GT, Bradford CR, Chepeha DB, Eisbruch A: Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol. 2010, 28: 2732-2738. 10.1200/JCO.2009.24.6199.PubMedCentralCrossRefPubMed

39.

Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M: AJCC Cancer Staging Manual. New York: Springer-Verlag. 2002, 6: 33-46.

40.

Gregoire V, Levendag P, Ang KK, Bernier J, Braaksma M, Budach V, Chao C, Coche E, Cooper JS, Cosnard G, Eisbruch A, El-Sayed S, Emami B, Grau C, Hamoir M, Lee N, Maingon P, Muller K, Reychler H: CT-based delineation of lymph node levels related CTVs in the node negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol. 2003, 69: 227-236. 10.1016/j.radonc.2003.09.011.CrossRefPubMed

41.

Gregoire V, Eisbruch A, Hamoir M, Levendag P: Proposal for the delineation of the nodal CTV in the node-positive and post-operative neck. Radiother Oncol. 2006, 79: 15-20. 10.1016/j.radonc.2006.03.009.CrossRefPubMed

42.

Miller AB, Hoogstraten B, Staquet M, Winkler A: Reporting results of cancer treatment. Cancer. 1981, 47: 207-214. 10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6.CrossRefPubMed

43.

Kaplan EL, Meier P: Nonparametric estimation for incomplete observation. J Am Stat Assoc. 1958, 53: 457-481. 10.1080/01621459.1958.10501452.CrossRef

44.

Domenge C, Hill C, Lefebre JL, De Raucourt D, Rhein B, Wibault P, Marandas P, Coche-Dequeant B, Stromboni-Luboinski M, Sancho-Garnier H, Luboinski B: Randomized trial of neoadjuvant chemotherapy in oropharyngeal carcinoma. French Groupe d’Etude des Tumeurs de la Tête et du Cou (GETTEC). Br J Cancer. 2000, 83: 1594-1598. 10.1054/bjoc.2000.1512.PubMedCentralCrossRefPubMed

45.

Cmelak AJ, Li S, Goldwasser MA, Murphy B, Cannon M, Pinto H, Rosenthal DI, Gillison M, Forastiere AA: Phase II trial of chemoradiation for organ preservation in resectable stage III or IV squamous cell carcinomas of the larynx or oropharynx: results of Eastern Cooperative Oncology Group Study E2399. J Clin Oncol. 2007, 25: 3971-3977. 10.1200/JCO.2007.10.8951.CrossRefPubMed

46.

Forastiere AA, Trotti A: Radiotherapy and concurrent chemotherapy: a strategy that improves locoregional control and survival in oropharyngeal cancer. J Natl Cancer Inst. 1999, 91: 2065-2066. 10.1093/jnci/91.24.2065.CrossRefPubMed

47.

Olmi P, Crispino S, Fallai C, Torri V, Rossi F, Bolner A, Amichetti M, Signor M, Taino R, Sguadrelli M, Colombo A, Ardizzoia A, Ponticelli P, Franchin G, Minatel E, Gobitti C, Atzeni G, Gava A, Flann M, Marsoni S: Locoregionally advanced carcinoma of the oropharynx: conventional radiotherapy vs. accelerated hyperfractionated radiotherapy vs. concomitant radiotherapy and chemotherapy-a multicenter randomized trial. Int J Radiat Oncol Biol Phys. 2003, 55: 78-92. 10.1016/S0360-3016(02)03792-6.CrossRefPubMed

48.

Fallai C, Bolner A, Signor M, Gava A, Franchin G, Ponticelli P, Taino R, Rossi F, Ardizzoia A, Oggionni M, Crispino S, Olmi P: Long-term results of conventional radiotherapy versus accelerated hyperfractionated radiotherapy versus concomitant radiotherapy and chemotherapy in locoregionally advanced carcinoma of the oropharynx. Tumori. 2006, 92: 41-54.PubMed

49.

Kokubo M, Nagata Y, Nishimura Y, Kimura H, Shoji K, Asato R, Sasai K, Hiraoka M: Concurrent chemoradiotherapy for oropharyngeal carcinoma. Am J Clin Oncol. 2001, 24: 71-76. 10.1097/00000421-200102000-00013.CrossRefPubMed

50.

Ohnishi K, Shioyama Y, Nakamura T, Ohga S, Nonoshita T, Yoshitake T, Terashima K, Komune S, Honda H: Concurrent chemoradiotherapy with S-1 as first-line treatment for patients with oropharyngeal cancer. J Radiat Res. 2011, 52: 47-53. 10.1269/jrr.10081.CrossRefPubMed

51.

Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A, Mechalakos J, Venkatraman ES, Kraus D, Shaha A, Shah JP, Pfister DG, Zelefsky MJ: A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006, 66: 966-974. 10.1016/j.ijrobp.2006.06.040.CrossRefPubMed

52.

Lovey J, Koronczay K, Remenar E, Csuka O, Nemeth G: Radiotherapy and concurrent low-dose paclitaxel in locally advanced head and neck cancer. Radiother Oncol. 2003, 68: 171-174. 10.1016/S0167-8140(03)00199-3.CrossRefPubMed

53.

Suzuki M, Nishimura Y, Nakamatsu K, Kanamori S, Koike R, Kawamoto M, Mori K: Phase I study of weekly docetaxel infusion and concurrent radiation therapy for head and neck cancer. Jpn J Clin Oncol. 2003, 33: 297-301. 10.1093/jjco/hyg054.CrossRefPubMed

54.

Pergolizzi S, Adamo V, Ferraro G, Sergi C, Santacaterina A, Romeo A, De Renzis C, Zanghi M, Rossello R, Settineri N: Induction chemotherapy to weekly paclitaxel concurrent with curative radiotherapy in stage IV (M0) unresectable head and neck squamous cell carcinoma: a dose escalation study. J Chemother. 2004, 16: 201-205.CrossRefPubMed

55.

Fukada J, Shigematsu N, Takeda A, Ohashi T, Tomita T, Shiotani A, Kuneida E, Kawaguchi O, Fujii M, Kubo A: Weekly low-dose docetaxel-based chemoradiotherapy for locally advanced oropharyngeal or hypopharyngeal carcinoma: a retrospective, single institution study. Int J Radiat Oncol Biol Phys. 2010, 76: 417-424. 10.1016/j.ijrobp.2009.01.056.CrossRefPubMed

56.

Jain RK, Kirar P, Gupta G, Dubey S, Gupta SK, Goyal J: A comparative study of low dose weekly paclitaxel versus cisplatin with concurrent radiation in the treatment of locally advanced head and neck cancer. Indian J Cancer. 2009, 46: 50-53. 10.4103/0019-509X.48596.CrossRefPubMed

57.

Vokes EE, Kies MS, Haraf DJ, Stenson K, List M, Humerickhouse R, Dolan ME, Pelzer H, Sulzen L, Witt ME, Hsieh YC, Mittal BB, Weichselbaum RR: Concomitant chemoradiotherapy as primary treatment for locoregionally advanced head and neck cancer. J Clin Oncol. 2000, 18: 1652-1661.PubMed

58.

Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS: Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: A University of Pennsylvania phase II trial. J Clin Oncol. 2002, 20: 3964-3971. 10.1200/JCO.2002.11.026.CrossRefPubMed

59.

Ho T, Zahurak M, Koch WM: Prognostic significance of presentation-to-diagnosis interval in patients with oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2004, 130: 45-51. 10.1001/archotol.130.1.45.CrossRefPubMed

60.

Agarwal JP, Mallick I, Bhutani R, Ghosh-Laskar S, Gupta T, Budrukkar A, Murthy V, Sengar M, Dinshaw KA: Prognostic factors in oropharyngeal cancer-analysis of 627 cases receiving definitive radiotherapy. Acta Oncol. 2009, 48: 1026-1033. 10.1080/02841860902845839.CrossRefPubMed

61.

Johansen LV, Grau C, Overgaard J: Squamous cell carcinoma of the oropharynx-an analysis of treatment results in 289 consecutive patients. Acta Oncol. 2000, 39: 985-994. 10.1080/02841860050215981.CrossRefPubMed

62.

Perez CA, Patel MM, Chao KS, Simpson JR, Sessions D, Spector GJ, Haughey B, Lockett MA: Carcinoma of the tonsillar fossa: prognostic factors and long-term therapy outcome. Int J Radiat Oncol Biol Phys. 1998, 42: 1077-1084. 10.1016/S0360-3016(98)00291-0.CrossRefPubMed

63.

Kumar P: Impact of anemia in patients with head and neck cancer. Oncologist. 2000, 5 (Suppl 2): 13-18.CrossRef

64.

Overgaard J, Hansen HS, Overgaard M, Bastholt L, Berthelsen A, Specht L, Lindelov B, Jorgensen K: A randomized double-blind phase III study of nimorazole as hypoxic radiosensitizer of primary radiotherapy in supraglottic larynx and pharynx carcinoma. Results form the Danish Head and Neck Cancer Study (DAHANCA). Protocol 5-85. Radiother Oncol. 1998, 46: 135-146. 10.1016/S0167-8140(97)00220-X.CrossRefPubMed

65.

Becker A, Stadler P, Lavey RS, Hansgen G, Kuhnt T, Lautenschlager C, Feldmann HJ, Molls M, Dunst J: Severe anemia is associated with poor tumor oxygenation in head and neck squamous cell carcinomas. Int J Radiat Oncol Biol Phys. 2000, 46: 459-466. 10.1016/S0360-3016(99)00384-3.CrossRefPubMed

66.

Nordsmark M, Overgaard J: A confirmatory prognostic study on oxygenation status and loco-regional control in advanced head and neck squamous cell carcinoma treated by radiation therapy. Radiother Oncol. 2000, 57: 39-43. 10.1016/S0167-8140(00)00223-1.CrossRefPubMed

67.

Nordsmark M, Bentzen SM, Rudat V, Brizel D, Lartigau E, Stadler P, Becker A, Adam M, Molls M, Dunst J, Terris DJ, Overgaard J: Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy: An international multi-center study. Radiother Oncol. 2005, 77: 18-24. 10.1016/j.radonc.2005.06.038.CrossRefPubMed

68.

Nordsmark M, Overgaard J: Tumor hypoxia is independent of hemoglobin and prognostic for loco-regional tumor control after primary radiotherapy in advanced head and neck cancer. Acta Oncol. 2004, 43: 396-403. 10.1080/02841860410026189.CrossRefPubMed

69.

Lassen P, Eriksen JG, Krogdahl A, Therkildsen MH, Ulhoi BP, Overgaard M, Specht L, Andersen E, Johansen J, Andersen LJ, Grau C, Overgaard J: The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: Evaluation of the randomized DAHANCA 6&7 trial. Radiother Oncol. 2011, 100: 49-55. 10.1016/j.radonc.2011.02.010.CrossRefPubMed

70.

Glaser CM, Millesi W, Kornek GV, Lang S, Schull B, Watzinger F, Selzer E, Lavey RS: Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys. 2001, 50: 705-715. 10.1016/S0360-3016(01)01488-2.CrossRefPubMed

71.

Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML: Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010, 363: 24-35. 10.1056/NEJMoa0912217.PubMedCentralCrossRefPubMed

72.

Licitra L, Perrone F, Bossi P, Suardi S, Mariani L, Artusi R, Oggionni M, Rossini C, Cantu G, Sguadrelli M, Quattrone P, Locati LD, Bergamini C, Olmi P, Pierotti MA, Pilotti S: High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. J Clin Oncol. 2006, 24: 5630-5636. 10.1200/JCO.2005.04.6136.CrossRefPubMed

73.

Lassen P, Eriksen JG, Hamilton-Dutoit S, Tramm T, Alsner J, Overgaard J: Effect of HPV-associated p16INK4A expression on response to radiotherapy and survival in squamous cell carcinoma of the head and neck. J Clin Oncol. 2009, 27: 1992-1998. 10.1200/JCO.2008.20.2853.CrossRefPubMed

Title: Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors
Authors: Valentina Krstevska
Igor Stojkovski
Beti Zafirova-Ivanovska
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-78

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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