Prognosis in head and neck cancer: the importance of the patient-, and treatment-related factors

Abstract

Objective: To investigate the importance of comorbidity, performance status, hemoglobin level, weight loss, interruption of radiotherapy, and mucositis as prognostic factors in head and neck cancer patients. Methods: Two-hundred and ten patients who were admitted to the Oncology Center of our university between 2006 and 2012, and treated for head and neck cancer were included in the study. Performance status at admission was evaluated according to Eastern Cooperative Oncology Group (ECOG) scoring system. Staging of the disease was based on TNM staging system revised in 2010. Results: The median follow-up period was 24 (range: 1-134) months. Recurrence was observed in 24% of the patients in a median 11 (range: 3-96) months. Metastasis was observed in 13% of patients, in the median 15 (range: 1-134 months). The 3-year local control, overall survival and disease-free survival rates were 72%, 59%, and 53%, respectively for all patients. The factors affecting the 3-year local control rates in univariate analysis were performance status (p=0.006), weight loss (p=0.002), localization (p=0.003), and stage (p

Keywords

• Head and neck cancer, weight loss, hemoglobin

Baş boyun kanserlerinde prognoz: Hasta ve tedaviyle ilişkili faktörlerin önemi

Öz

Amaç: Bu çalışmanın amacı baş boyun kanserinde prognostik faktör olarak komorbidite, performans durumu, hemoglobin düzeyi, kilo kaybı, radyoterapiye ara verme ve mukozitin öneminin araştırılmasıdır. Yöntem: Üniversitesimizin Onkoloji Merkezine 2006 ve 2012 tarihleri arasında, baş boyun kanseri tanısı ile tedavi edilen 210 hastanın verileri incelendi. Hastaların performans durumu, hasta başvurusunda Eastern Cooperative Oncology Group (ECOG) skorlama sistemine göre değerlendirildi. Hastalık evresi 2010'da revize edilen TNM evrelemesine göre yapıldı. Bulgular: Hastalar, medyan 24 (dağılım: 1-134) ay takip edildi. Medyan 11 (dağılım: 3-96) ayda hastaların %24'ünde nüks gelişirken, medyan 15 (dağılım: 1-134) ayda %13'ünde uzak metastaz gelişti. Tüm hastalar için 3 yıllık lokal kontrol %72, 3 yıllık genel sağkalım %59, 3 yıllık hastalıksız sağkalım %53 idi. Tek değişkenli analizde hastaların lokal kontrol oranlarını performans durumu (p=0.006), kilo kaybı (p=0.002), hastalık lokalizasyonu (p=0.003), evre (p

Anahtar Kelimeler

• Baş boyun kanseri, kilo kaybı, hemoglobin

References

1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statis- tics, 2009. CA Cancer J Clin 2009;59:225-49.
2. Haydaro¤lu A, Bölükbaflı Y, Özsaran Z. Ege Üniversitesi’nde kanser kayıt analizleri: 34134 Olgunun de¤erlendirmesi. Türk Onkoloji Dergisi 2007;22:22-8.
3. Bourhis J, Overgaard J, Audry H, et al.; Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH) Collaborative Group. Hyperfractionated or accelerated radiother- apy in head and neck cancer: a meta-analysis. Lancet 2006;368: 843-54.
4. Zhang SY, Lu ZM, Luo XN, et al. Retrospective analysis of prog- nostic factors in 205 patients with laryngeal squamous cell carcino- ma who underwent surgical treatment. PLoS One 2013;8:e60157.
5. Chen AY, Matson LK, Roberts D, Goepfert H. The significance of comorbidity in advanced laryngeal cancer. Head Neck 2001;23: 566-72.
6. Montero EH, Trufero JM, Romeo JA, Terré FC. Comorbidity and prognosis in advanced hypopharyngeal-laryngeal cancer under combined therapy. Tumori 2008;94:24-9.
7. Taylor SG 4th, Murthy AK, Vannetzel JM, et al. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion fol- lowed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 1994;12:385-95.
8. Jones AS, Fenton JE, Husband DJ. Performance data and survival in head and neck cancer. Clin Otolaryngol Allied Sci 2000;25:396- 403.

9. Chang PH, Yeh KY, Huang JS, et al. Pretreatment performance status and nutrition are associated with early mortality of locally advanced head and neck cancer patients undergoing concurrent chemoradiation. Eur Arch Otorhinolaryngol 2013;270:1909-15.
10. Rades D, Seibold ND, Gebhard MP, Noack F, Schild SE, Thorns C. Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlenther Onkol 2011;187:626-32.
11. Dische S. Radiotherapy and anemia – the clinical experience. Radiother Oncol 1991;20:35-40.
12. Rutkowski T, Wygoda A, Skladowski K, et al. Predictors of radio- therapy outcome in patients with T2 supraglottic carcinoma. Eur Arch Otorhinolaryngol 2012;269:923-9.
13. van Acht MJ, Hermans J, Boks DE, Leer JW. The prognostic value of hemoglobin and a decrease in hemoglobin during radiotherapy in laryngeal carcinoma. Radiother Oncol 1992;23:229-35.
14. Tarnawski R, Skladowski K, Maciejewski B. Prognostic value of hemoglobin concentration in radiotherapy for cancer of supraglot- tic larynx. Int J Radiat Oncol Biol Phys 1997;38:1007-11.
15. McCloskey SA, Jaggernauth W, Rigual NR, et al. Radiation treat- ment interruptions greater than one week and low hemoglobin lev- els (12 g/dL) are predictors of local regional failure after definitive concurrent chemotherapy and intensity-modulated radiation ther- apy for squamous cell carcinoma of the head and neck. Am J Clin Oncol 2009;32:587-91.
16. Jager-Wittenaar H, Dijkstra PU, Vissink A, et al. Critical weight loss in head and neck cancer – prevalence and risk factors at diag- nosis: an explorative study. Support Care Cancer 2007;15:1045-50.
17. Beaver ME, Matheny KE, Roberts DB, Myers JN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 2001;125:645-8.
18. Mangar S, Slevin N, Mais K, Sykes A. Evaluating predictive fac- tors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: a retrospective review. Radiother Oncol 2006;78:152-8.
19. Lees J. Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) 1999;8:133-6.
20. Feyer PC, Maranzano E, Molassiotis A, Roila F, Clark-Snow RA, Jordan K; MASCC/ESMO. Radiotherapy-induced nausea and vomiting (RINV): MASCC/ESMO guideline for antiemetics in radiotherapy: update 2009. Support Care Cancer 2011;19 Suppl 1: S5-14.
21. Nourissat A, Bairati I, Samson E, et al. Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer. Cancer 2010;116:2275-83.
22. Nourissat A, Bairati I, Fortin A, et al. Factors associated with weight loss during radiotherapy in patients with stage I or II head and neck cancer. Support Care Cancer 2012;20:591-9.
23. van Bokhorst-de van der Schuer, van Leeuwen PA, Kuik DJ, et al. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 1999;86:519-27.
24. Regueiro CA, Aragón G, Millán I, Valcárcel FJ, de la Torre A, Magallón R. Prognostic factors for local control, regional control and survival in oropharyngeal squamous cell carcinoma. Eur J Cancer 1994;30A:2060-7.
25. Hammerlid E, Wirblad B, Sandin C, et al. Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head Neck 1998;20:540-8.
26. Russo G, Haddad R, Posner M, Machtay M. Radiation treatment breaks and ulcerative mucositis in head and neck cancer. Oncologist 2008;13:886-98.
27. Bese NS, Hendry J, Jeremic B. Effects of prolongation of overall treatment time due to unplanned interruptions during radiothera- py of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys 2007;68:654-61.
28. Tarnawski R, Fowler J, Skladowski K, et al. How fast is repopula- tion of tumor cells during the treatment gap? Int J Radiat Oncol Biol Phys 2002;54:229-36.
29. Barton MB, Keane TJ, Gadalla T, Maki E. The effect of treatment time and treatment interruption on tumour control following rad- ical radiotherapy of laryngeal cancer. Radiother Oncol 1992;23: 137-43.
30. Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992;23:457-67.
31. Lindstrom MJ, Fowler JF. Re-analysis of the time factor in local control by radiotherapy of T3T4 squamous cell carcinoma of the larynx. Int J Radiat Oncol Biol Phys 1991;21:813-7.
32. Fesinmeyer MD, Mehta V, Blough D, Tock L, Ramsey SD. Effect of radiotherapy interruptions on survival in medicare enrollees with local and regional head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;78:675-81.
33. Wolff HA, Bosch J, Jung K, et al. High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer. Strahlenther Onkol 2010;186:262-8.
34. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
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37. Please cite this article as: Yücel B, Eren MF, Akkafl Atesever E, Kaçan T, Hasbek Z, Şeker MM. Prognosis in head and neck cancer: the importance
38. of the patient-, and treatment-related factors. J Med Updates 2013;3(3):109-115.