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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Radiotherapy | Research

Prognostic impact of pathological complete remission after preoperative irradiation in patients with locally advanced head and neck squamous cell carcinoma: re-analysis of a phase 3 clinical study

Authors: Kai Wang, Junlin Yi, Xiaodong Huang, Yuan Qu, Jingwei Luo, Jianping Xiao, Shiping Zhang, Yuan Tang, Weixin Liu, Guozhen Xu, Li Gao, Zhengang Xu, Shaoyan Liu, Xiaolei Wang

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Purpose

The purpose of this study was to determine the associations between pathological complete remission (pCR) and clinical outcomes in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) who received preoperative radiotherapy or chemoradiotherapy in a phase 3 clinical study.

Methods

A total of 222 newly diagnostic stage III/IVM0 HNSCC patients were randomly assigned to a preoperative concurrent chemoradiotherapy group (n = 104) or preoperative radiotherapy alone group (n = 118). Over a mean follow-up of 59 months, 72 patients were defined as non-responders to preoperative therapy and subsequently underwent resection of the primary lesion with or without neck dissection. The relationship between the pathological tumor response of the primary lesion and treatment prognosis was analyzed. Kaplan–Meier and Cox regression multivariate analyses were performed to evaluate the impact of pCR on local control (LC), overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS).

Results

Among the 72 non-responders, 25 patients, 10 in the chemotherapy group and 15 in the radiotherapy group, achieved pCR. The 5-year LC, OS, PFS, and DMFS of pCR patients and non-pCR patients were 93.2% vs. 67.7% (p = 0.007), 83.3% vs. 39.7% (p = 0.0006), 76.1% vs. 44.0% (p = 0.009), and 90.4% vs. 56.3% (p = 0.005), respectively. In multivariate analysis, pCR is also an independent prognostic factor in prognosis, with statistically significant differences.

Conclusion

pCR after preoperative radiotherapy or concurrent chemoradiotherapy is a good prognostic factor in locally advanced HNSCC.

Trial registration

Number:ChiCTR-TRC-114004322
Date:05 Mar, 2014
Appendix
Available only for authorised users
Literature
1.
Pfister DG, Ang K, Brockstein B, Colevas AD, Ellenhorn J, Goepfert H, et al. NCCN practice guidelines for head and neck cancers. Oncology (Williston Park). 2000;14(11A):163–94.
2.
Kramer S, Gelber RD, Snow JB, Marcial VA, Lowry LD, Davis LW, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the radiation therapy oncology group. Head Neck Surg. 1987;10(1):19–30.CrossRef
3.
Jesse RH, Fletcher GH. Treatment of the neck in patients with squamous cell carcinoma of the head and neck. Cancer. 1977;39(2 Suppl):868–72.CrossRef
4.
Mucke T, Konen M, Wagenpfeil S, Kesting MR, Wolff KD, Holzle F. Low-dose preoperative chemoradiation therapy compared with surgery alone with or without postoperative radiotherapy in patients with head and neck carcinoma. Ann Surg Oncol. 2011;18(10):2739–47.CrossRef
5.
del Campo JM, Felip E, Giralt J, Raspall G, Bescos S, Casado S, et al. Preoperative simultaneous chemoradiotherapy in locally advanced cancer of the oral cavity and oropharynx. Am J Clin Oncol. 1997;20(1):97–100.CrossRef
6.
Giralt JL, Gonzalez J, del Campo JM, Maldonado J, Sanz X, Pamias J, et al. Preoperative induction chemotherapy followed by concurrent chemoradiotherapy in advanced carcinoma of the oral cavity and oropharynx. Cancer. 2000;89(5):939–45.CrossRef
7.
Kirita T, Ohgi K, Tsuyuki M, Kamikaido N, Yamamoto K, Sugimura M. Preoperative simultaneous cisplatin- or carboplatin-based chemotherapy and radiotherapy for squamous cell carcinoma of the oral cavity. J Surg Oncol. 1996;63(4):240–8.CrossRef
8.
Kirita T, Yamanaka Y, Imai Y, Yamakawa N, Aoki K, Nakagawa Y, et al. Preoperative concurrent chemoradiotherapy for stages II-IV oral squamous cell carcinoma: a retrospective analysis and the future possibility of this treatment strategy. Int J Oral Maxillofac Surg. 2012;41(4):421–8.CrossRef
9.
Klug C, Berzaczy D, Voracek M, Millesi W. Preoperative chemoradiotherapy in the management of oral cancer: a review. J Cranio-maxillo-facial Surg. 2008;36(2):75–88.CrossRef
10.
Onizawa K, Yoshida H, Ohara K, Noguchi M. Predictive factors for the histologic response to preoperative radiotherapy in advanced oral cancer. J Oral Maxillofac Surg. 2006;64(1):81–6.CrossRef
11.
Yi J, Huang X, Xu Z, Liu S, Wang X, He X, et al. Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Oncotarget. 2017;8(27):44842–50.CrossRef
12.
Kirita T, Ohgi K, Shimooka H, Yamanaka Y, Tatebayashi S, Yamamoto K, et al. Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results. Oral Oncol. 1999;35(6):597–606.CrossRef
13.
Friesland S, Fernberg JO, Lundell G, Munck-Wikland E, Strander H, Lewensohn R. Prognostic impact of complete remission after preoperative irradiation of tonsillar carcinoma: a retrospective analysis of the radiumhemmet data, 1980-1995. Int J Radiat Oncol Biol Phys. 1999;45(5):1259–66.CrossRef
14.
Kirita T, Shimooka H, Yamanaka Y, Tatebayashi S, Yamamoto K, Nishimine M, et al. Prognostic value of response to preoperative chemoradiotherapy and residual tumor grades in tongue carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(3):293–300.CrossRef
15.
Brun E, Zatterstrom U, Kjellen E, Wahlberg P, Willen R, Brun A, et al. Prognostic value of histopathological response to radiotherapy and microvessel density in oral squamous cell carcinomas. Acta Oncol. 2001;40(4):491–6.CrossRef
16.
Homann N, Pauligk C, Luley K, Werner Kraus T, Bruch HP, Atmaca A, et al. Pathological complete remission in patients with oesophagogastric cancer receiving preoperative 5-fluorouracil, oxaliplatin and docetaxel. Int J Cancer. 2012;130(7):1706–13.CrossRef
17.
Lowy AM, Mansfield PF, Leach SD, Pazdur R, Dumas P, Ajani JA. Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg. 1999;229(3):303–8.CrossRef
18.
Cheedella NK, Suzuki A, Xiao L, Hofstetter WL, Maru DM, Taketa T, et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol. 2013;24(5):1262–6.CrossRef
19.
Lorenzen S, Thuss-Patience P, Al-Batran SE, Lordick F, Haller B, Schuster T, et al. Impact of pathologic complete response on disease-free survival in patients with esophagogastric adenocarcinoma receiving preoperative docetaxel-based chemotherapy. Ann Oncol. 2013;24(8):2068–73.CrossRef
20.
Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014;32(15):1554–62.CrossRef
21.
Abdul-Jalil KI, Sheehan KM, Kehoe J, Cummins R, O'Grady A, McNamara DA, et al. The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer. Color Dis. 2014;16(1):O16–25.CrossRef
22.
Ayloor Seshadri R, Kondaveeti SS, Jayanand SB, John A, Rajendranath R, Arumugam V, et al. Complete clinical response to neoadjuvant chemoradiation in rectal cancers: can surgery be avoided? Hepato-gastroenterology. 2013;60(123):410–4.PubMed
23.
Hellmann MD, Chaft JE, William WN Jr, Rusch V, Pisters KM, Kalhor N, et al. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet Oncol. 2014;15(1):e42–50.CrossRef
24.
Guiu S, Arnould L, Bonnetain F, Dalban C, Favier L, Desmoulins I, et al. Pathological response and survival after neoadjuvant therapy for breast cancer: a 30-year study. Breast. 2013;22(3):301–8.CrossRef
25.
Kong X, Moran MS, Zhang N, Haffty B, Yang Q. Meta-analysis confirms achieving pathological complete response after neoadjuvant chemotherapy predicts favourable prognosis for breast cancer patients. Eur J Cancer. 2011;47(14):2084–90.CrossRef
26.
Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Clinical criteria underestimate complete pathological response in rectal cancer treated with neoadjuvant chemoradiotherapy. Dis Colon Rectum. 2014;57(3):311–5.CrossRef
27.
Hatakenaka M, Nakamura K, Yabuuchi H, Shioyama Y, Matsuo Y, Ohnishi K, et al. Pretreatment apparent diffusion coefficient of the primary lesion correlates with local failure in head-and-neck cancer treated with chemoradiotherapy or radiotherapy. Int J Radiat Oncol Biol Phys. 2011;81(2):339–45.CrossRef
28.
Vandecaveye V, Dirix P, De Keyzer F, Op de Beeck K, Vander Poorten V, Hauben E, et al. Diffusion-weighted magnetic resonance imaging early after chemoradiotherapy to monitor treatment response in head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2012;82(3):1098–107.CrossRef
29.
Jacobs L, Intven M, van Lelyveld N, Philippens M, Burbach M, Seldenrijk K, et al. Diffusion-weighted MRI for early prediction of treatment response on preoperative Chemoradiotherapy for patients with locally advanced rectal Cancer: a feasibility study. Ann Surg. 2016;263(3):522–8.CrossRef
30.
Ceulemans G, Voordeckers M, Farrag A, Verdries D, Storme G, Everaert H. Can 18-FDG-PET during radiotherapy replace post-therapy scanning for detection/demonstration of tumor response in head-and-neck cancer? Int J Radiat Oncol Biol Phys. 2011;81(4):938–42.CrossRef
31.
Hur H, Tulina I, Cho MS, Min BS, Koom WS, Lim JS, et al. Biomarker-based scoring system for prediction of tumor response after preoperative Chemoradiotherapy in rectal Cancer by reverse transcriptase polymerase chain reaction analysis. Dis Colon Rectum. 2016;59(12):1174–82.CrossRef
32.
Elshafeey N, Hassan I, Zinn PO, Colen RR. From K-space to nucleotide: insights into the Radiogenomics of brain tumors. Top Magnet Reson Imaging : TMRI. 2017;26(1):33–41.
33.
Sala E, Mema E, Himoto Y, Veeraraghavan H, Brenton JD, Snyder A, et al. Unravelling tumour heterogeneity using next-generation imaging: radiomics, radiogenomics, and habitat imaging. Clin Radiol. 2017;72(1):3–10.CrossRef
Metadata
Title
Prognostic impact of pathological complete remission after preoperative irradiation in patients with locally advanced head and neck squamous cell carcinoma: re-analysis of a phase 3 clinical study
Authors
Kai Wang
Junlin Yi
Xiaodong Huang
Yuan Qu
Jingwei Luo
Jianping Xiao
Shiping Zhang
Yuan Tang
Weixin Liu
Guozhen Xu
Li Gao
Zhengang Xu
Shaoyan Liu
Xiaolei Wang
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Radiotherapy
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1428-4

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