The Efficacy, Prognostic Factors And Long-term Organ Functions Of Loco-regionally Advanced Squamous Cell Carcinoma Of The Head And Neck After Been Treated With Multi-modality Approach

Objectives:To investigate the treatment outcome of loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) after been treated with multi-modality approach since2005in our hospital and to explore the prognostic factors for treatment outcomes.Material and Methods:Clinical data of125postoperative LA-SCCHN patients treated in our department with radiotherapy/chemoradiotherapy from May2005to December2011were collected and reviewed in this study. The radiotherapy technique was intensity-modulated radiotherapy (IMRT)(93.6%) and a minority of3D-conformal radiotherapy (3D-CRT). SPSS18.0software was used for calculating the treatment outcome and analyzing the prognostic factors.Results:Up to January6th,2013,124patients were followed up with a median follow up duration of25months. The3-year overall survival (OS), loco-regional control rate (LRCR), distant metastasis-free survival (DMFS), Disease-free survival (DFS) were69.7%,80.8%,73.1%and56.1%, respectively. A total of37patients died during follow up. Among the43patients who presented with treatment failure,13patients had loco-regional relapse,20patients had distant metastasis and10patients presented with both loco-regional and distant relapses. Distant metastasis accounts for the predominant cause of death. Lungs and mediastinal lymph nodes are the most common sites involved by distant metastasis. Univariate analysis indicated that patients with higher N stage (N2b and above), non-radical surgery, larger size of invaded lymph nodes and vascular embolisms had lower OS (P=0.032,0.001,0.000,0.007, respectively); T4had a negative influence on local control (p=0.033); patients who underwent non-radical surgery, with larger invaded lymph nodes, or with higher TNM stage had a poorer regional control (p=0.000,0.000,0.001, respectively); patients with higher N stage (N2b and above), higher TNM stage, and vascular embolisms had higher distant metastasis rates (P=0.002,0.008,0.001, respectively). In multivariate analysis, non-radical surgery was the independent prognostic factor for OS (P=0.001), vascular embolisms were of boarderline significance for OS (p=0.056); larger size of invaded lymph nodes was the independent prognostic factors for poorer LRCR (p=0.001); higher N stage (N2b and above), T4stage and vascular embolisms were the independent prognostic factors for poorer DMFS (P=0.035,0.008and0.050, respectively).Conclusions:Multi-modality treatment for LA-SCCHN had achieved better outcome than before. Distant metastasis has become the predominant pattern of failure as well as the primary cause of death instead of loco-regional relapse as a result of improved local control modality. More efforts should be devoted to decrease the rate of distant metastasis in the future. Objective:The aim of this study is to analyze retrospectively the efficacy and organ function of patients with loco-regionally advanced laryngeal and hypopharyngeal carcinoma after been treated with surgery plus postoperative adjuvant therapy.Materials and Methods:A total of85patients with loco-regionally advanced (AJCC7th ed. Stage Ⅲ-ⅣB) Laryngeal and hypopharyngeal squamous cell carcinoma were reviewed. They all have recieved surgery plus postoperative adjuvant therapy including intensity-modulated radiotherapy (IMRT) in our institute from May2005to October2011. The median follow-up period is26months. Overall survival (OS), Disease-free survival (DFS), locoregional control rate (LRCR), distant metastasis-free survival (DMFS) were calculated by means of Kaplan-Meier method and tested by log-rank test. Prognostic factors were analyzed through univariate and multivariate analysis by Kaplan-Meier method and Cox regression model respectively. Functional results and QoL were collected and graded according to EORTC H&N35-QoQ, CTCAE v4.0, and PSS-HN Scale.Results:The3-year OS, DFS, LRFFS and DMFS was68.1%,59.6%,85.1%and73.0%, respectively. Non-radical surgery and vascular embolism were the independent prognostic factors for poorer OS (p=0.011and0.051, respectively); higher N stage (N2b-N3), non-radical surgery and vascular embolism were the independent factors for poorer DFS (p=0.011,0.023and0.044, respectively); non-radical surgery was the independent factor affecting locoregional control (p=0.026). T4stage, higher N stage (N2b-N3) as well as vascular embolism are the independent factors for distant metastasis (p=0.032,0.030and0.032, respectively). Among61patients been estimated for QoL and functional results,42patients could present with intelligible speech (including40underwent partial laryngectomy (PL) and2underwent total laryngectomy (TL)).18patients lived with permanent tracheostoma;38of the43patients who underwent PL closed tracheostoma within one year after treatment. No patient report moderate to severe dyspnea. Conclusions:For loco-regionally advanced laryngeal and hypopharyngeal cancer, larynx-preserving surgery plus IMRT-based adjuvant therapy can achieve relatively satisfying oncologic results as well as functional preservation and QoL. Distant metastases have become the the predominant problem nowadays. More efforts should be devoted to the control of distant metastases, especially for patients with T4stage and/or N2b-N3stage and/or vascular embolism.