Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gewählte Publikation:

Mollnar, S.
Definitive radiochemotherapy with and without induction chemotherapy in patients with head and neck cancer - A retrospective comparative effectiveness study
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2019. pp. 84 [OPEN ACCESS]


Autor*innen der Med Uni Graz:
Posch Florian
Stöger Herbert

Background Definitive radiochemotherapy (CRT) is the current standard of care for patients with locally advanced head and neck cancer. However, recent studies indicate that prior induction chemotherapy (ICT) might improve progression free survival and reduce distant metastasis. Whether ICT improves outcomes in terms of overall survival in this patient population is still debated. To obtain further scientific evidence on these questions, we conducted a retrospective comparative effectiveness study in patients with head and neck cancer, who received CRT +/- ICT. Methods In this single-centre, observational, retrospective cohort study we included 195 head and neck squamous cell carcinoma patients, who received CRT at the department of ENT of the Medical University of Graz. The median age of the study population was 59 years and 73% had an ECOG Performance status grade 0. 76 patients (39%) received an ICT prior to concomitant CRT, the regimen for the induction treatment was TPF (consisting of Cisplatin, Docetaxel, 5-FU) for most of the patients (82%). Co-primary endpoints were progression-free survival (PFS) and overall survival (OS). An inverse-probability-of-treatment-weight (IPTW) analysis was conducted to generate a quasi-experimental setting with observational, retrospective data. Results During a median follow-up of 3.6 years for progression and 4.3 years for overall survival we observed 66 disease progressions and 83 patients died. 5-year OS and PFS estimates were 50% and 47%, respectively. Local progression rate after 5 years was 35%, and the corresponding rate for distant metastasis was 19%. Importantly, we observed significant differences in the distribution of baseline covariates between the two study groups. For example, patients who received ICT were significantly younger (p=0.0001), had fewer comorbidities (p=0.0001), were less likely to have a second primary malignancy (p=0.03) and had better ECOG Performance status (p=0.0001). After re-weighing of the data with the IPTW most imbalances between the two treatment groups were removed. IPTW-adjusted analysis of OS did not support the hypothesis that ICT is associated with improved survival (Hazard Ratio (HR)=0.96, 95%CI: 0.46-1.63, p=0.65). However, after full IPTW adjustment, the rate of distant metastasis was significantly lower with ICT+CRT than with CRT alone (HR=0.38, 95%CI: 0.16-0.94, p=0.04). Conclusion The results of this non-randomised study fully corroborate previous randomised trials which showed that ICT improves systemic disease control by reducing the risk of distant metastasis. However, the data of this study suggest that this benefit does not translate into a meaningful improvement in OS. Therefore, each indication for ICT should be carefully assessed for every patient, weighing potential benefits and harms. For example, ICT+CRT may be considered an effective treatment strategy for patients presumed to have a very high systemic risk, or for patients who prefer an organ-preserving treatment strategy, especially in cases of laryngeal carcinoma.  

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