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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)open access

Authors
Lee, Yun-GyooKang, Eun JooKeam, BhumsukChoi, Jin-HyukKim, Jin-SooPark, Keon UkLee, Kyoung EunKim, Hyo JungLee, Keun-WookKim, Min KyoungAhn, Hee KyungShin, Seong HoonKim, Hye RyunKim, Sung-BaeYun, Hwan Jung
Issue Date
1월-2022
Publisher
KOREAN CANCER ASSOCIATION
Keywords
Locally advanced head and neck squamous cell carcinoma; Induction chemotherapy; Subsequent treatment
Citation
CANCER RESEARCH AND TREATMENT, v.54, no.1, pp.109 - 117
Indexed
SCIE
SCOPUS
KCI
Journal Title
CANCER RESEARCH AND TREATMENT
Volume
54
Number
1
Start Page
109
End Page
117
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/142006
DOI
10.4143/crt.2020.1329
ISSN
1598-2998
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.
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