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• W1992697495 abstract "Purpose/Objective(s)We retrospectively evaluated the role of postoperative CCRT in the patients with locally advanced SCCHN and focused on the importance of patients' selection to obtain therapeutic gain in trimodality therapy.Materials/MethodsFrom March, 1993 to July, 2008, 112 patients with locally advanced SCCHN who had undergone macroscopically complete resection were evaluated. We compared the overall survival (OS) and the disease-free survival (DFS) between postoperative radiotherapy arm in early period (1993∼2003) and postoperative CCRT arm in late period (2003∼2008). The cumulative incidence of local or regional relapse, metastasis, secondary primary tumors and acute adverse effects were analyzed.ResultsThe median follow-up period of the patients was 71 months. The locoregional failure rate for the radiotherapy arm was significantly higher than that for the CCRT arm (20.9% vs. 4.0%, p = 0.01). Even though, having of unfavorable prognostic factors in CCRT arm, there was a trend of improved OS and DFS at three years in favor of the CCRT arm (70% vs. 52.5%, p = 0.772, 66.1% vs. 58.5%, p = 0.226). However, there is no difference of survival between postoperative RT arm and CCRT arm within 1 year, then the survival gap appeared after 1 year. 13 patients were dead early during the first year of follow-up in CCRT arm. These early succumbs in CCRT arm had characteristics compared with remaining patients: poor performance status, extracapsular-extended node, old age over sixty (p < 0.05). The incidence of grade 3 or 4 hematologic and mucosal toxicity was significantly higher in the CCRT arm than that in the radiotherapy arm. (38.0% vs. 1.6%, p = 0.001, 40.0% vs. 19.4%, p = 0.030, respectively).ConclusionsOur study suggests that postoperative CCRT is more efficacious than radiotherapy alone in patients with locally advanced SCCHN. However, trimodality therapy of curative surgery followed by chemoradiotherapy is too intensive and toxic for patients of poor performance status and old aged patients. Thus, physicians consider less intensive treatment option. For patients of high risk of early distant metastasis is also needed sophisticated treatment decision such as neoadjuvant chemotherapy or definitive CCRT to improve therapeutic gain. Purpose/Objective(s)We retrospectively evaluated the role of postoperative CCRT in the patients with locally advanced SCCHN and focused on the importance of patients' selection to obtain therapeutic gain in trimodality therapy. We retrospectively evaluated the role of postoperative CCRT in the patients with locally advanced SCCHN and focused on the importance of patients' selection to obtain therapeutic gain in trimodality therapy. Materials/MethodsFrom March, 1993 to July, 2008, 112 patients with locally advanced SCCHN who had undergone macroscopically complete resection were evaluated. We compared the overall survival (OS) and the disease-free survival (DFS) between postoperative radiotherapy arm in early period (1993∼2003) and postoperative CCRT arm in late period (2003∼2008). The cumulative incidence of local or regional relapse, metastasis, secondary primary tumors and acute adverse effects were analyzed. From March, 1993 to July, 2008, 112 patients with locally advanced SCCHN who had undergone macroscopically complete resection were evaluated. We compared the overall survival (OS) and the disease-free survival (DFS) between postoperative radiotherapy arm in early period (1993∼2003) and postoperative CCRT arm in late period (2003∼2008). The cumulative incidence of local or regional relapse, metastasis, secondary primary tumors and acute adverse effects were analyzed. ResultsThe median follow-up period of the patients was 71 months. The locoregional failure rate for the radiotherapy arm was significantly higher than that for the CCRT arm (20.9% vs. 4.0%, p = 0.01). Even though, having of unfavorable prognostic factors in CCRT arm, there was a trend of improved OS and DFS at three years in favor of the CCRT arm (70% vs. 52.5%, p = 0.772, 66.1% vs. 58.5%, p = 0.226). However, there is no difference of survival between postoperative RT arm and CCRT arm within 1 year, then the survival gap appeared after 1 year. 13 patients were dead early during the first year of follow-up in CCRT arm. These early succumbs in CCRT arm had characteristics compared with remaining patients: poor performance status, extracapsular-extended node, old age over sixty (p < 0.05). The incidence of grade 3 or 4 hematologic and mucosal toxicity was significantly higher in the CCRT arm than that in the radiotherapy arm. (38.0% vs. 1.6%, p = 0.001, 40.0% vs. 19.4%, p = 0.030, respectively). The median follow-up period of the patients was 71 months. The locoregional failure rate for the radiotherapy arm was significantly higher than that for the CCRT arm (20.9% vs. 4.0%, p = 0.01). Even though, having of unfavorable prognostic factors in CCRT arm, there was a trend of improved OS and DFS at three years in favor of the CCRT arm (70% vs. 52.5%, p = 0.772, 66.1% vs. 58.5%, p = 0.226). However, there is no difference of survival between postoperative RT arm and CCRT arm within 1 year, then the survival gap appeared after 1 year. 13 patients were dead early during the first year of follow-up in CCRT arm. These early succumbs in CCRT arm had characteristics compared with remaining patients: poor performance status, extracapsular-extended node, old age over sixty (p < 0.05). The incidence of grade 3 or 4 hematologic and mucosal toxicity was significantly higher in the CCRT arm than that in the radiotherapy arm. (38.0% vs. 1.6%, p = 0.001, 40.0% vs. 19.4%, p = 0.030, respectively). ConclusionsOur study suggests that postoperative CCRT is more efficacious than radiotherapy alone in patients with locally advanced SCCHN. However, trimodality therapy of curative surgery followed by chemoradiotherapy is too intensive and toxic for patients of poor performance status and old aged patients. Thus, physicians consider less intensive treatment option. For patients of high risk of early distant metastasis is also needed sophisticated treatment decision such as neoadjuvant chemotherapy or definitive CCRT to improve therapeutic gain. Our study suggests that postoperative CCRT is more efficacious than radiotherapy alone in patients with locally advanced SCCHN. However, trimodality therapy of curative surgery followed by chemoradiotherapy is too intensive and toxic for patients of poor performance status and old aged patients. Thus, physicians consider less intensive treatment option. For patients of high risk of early distant metastasis is also needed sophisticated treatment decision such as neoadjuvant chemotherapy or definitive CCRT to improve therapeutic gain." @default.
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• W1992697495 date "2010-11-01" @default.
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• W1992697495 title "The Importance of Patient Selection for the Postoperative Concurrent Chemoradiotherapy (CCRT) to Improve Therapeutic Gain for Locally Advanced Squamous Cell Carcinoma of the Head and Neck (SCCHN)" @default.
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