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01-10-2011 | Head and Neck Oncology

Low-Dose Preoperative Chemoradiation Therapy Compared with Surgery Alone with or Without Postoperative Radiotherapy in Patients with Head and Neck Carcinoma

Authors: Thomas Mücke, MD, Mario Konen, MD, Stefan Wagenpfeil, MSc, PhD, Marco R. Kesting, MD, DDS, PhD, Klaus-Dietrich Wolff, MD, DDS, PhD, Frank Hölzle, MD, DDS, PhD

Published in: Annals of Surgical Oncology | Issue 10/2011

Abstract

Background

Several multimodal strategies have been developed to treat patients with squamous cell carcinoma of the oral cavity (OSCC), and many have shown survival benefits. The theoretical advantages of preoperative chemoradiotherapy are downstaging of the primary tumor, an increased resectability rate, and the elimination of micrometastases. We aimed to assess whether a short low-dose preoperative radiotherapy regimen with concurrent low-dose chemotherapy with cisplatin improves outcomes for patients with OSCC undergoing surgical treatment with curative intent.

Methods

A total of 407 patients received preoperative low-dose radiotherapy of 20 Gy given in 10 fractions with concurrent low-dose chemotherapy with cisplatin (12.5 mg/m²) as part of a pre-existing protocol. This was compared with 519 patients receiving surgery alone. Endpoints were overall survival, tumor response, and toxic effects. Analysis was controlled for tumor-related and demographic factors.

Results

After controlling for age, tumor stage, nodal stage, tumor grade, recurrence, and resection margin status, which were independent and dependent predictors of survival, preoperative radiotherapy was associated with improved survival [0.79; P = 0.002; 95% confidence interval (95% CI), 0.66–0.96], in patients receiving only preoperative radiation therapy or in combination with/without postoperative radiotherapy (1.31; P = 0.041; 95% CI, 1.01–1.70 with postoperative radiotherapy; 1.40; P = 0.039; 95% CI, 1.01–1.85 without postoperative radiotherapy).

Conclusions

Low-dose preoperative radiotherapy combined with low-dose chemotherapy with cisplatin significantly improves overall survival for patients with resectable OSCC compared with surgery alone.

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Title: Low-Dose Preoperative Chemoradiation Therapy Compared with Surgery Alone with or Without Postoperative Radiotherapy in Patients with Head and Neck Carcinoma
Authors: Thomas Mücke, MD
Mario Konen, MD
Stefan Wagenpfeil, MSc, PhD
Marco R. Kesting, MD, DDS, PhD
Klaus-Dietrich Wolff, MD, DDS, PhD
Frank Hölzle, MD, DDS, PhD
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 10/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-1643-1

At a glance: The STEP trials

Springer Medicine

Low-Dose Preoperative Chemoradiation Therapy Compared with Surgery Alone with or Without Postoperative Radiotherapy in Patients with Head and Neck Carcinoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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