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KMID : 0939920220540010109
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대한암학회지
2022 Volume.54 No. 1 p.109 ~ p.117
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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)
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Lee Yun-Gyoo
Kang Eun-Joo
Keam Bhum-Suk
Choi Jin-Hyuk
Kim Jin-Soo
Park Keon-Uk
Lee Kyoung-Eun
Kim Hyo-Jung
Lee Keun-Wook
Kim Min-Kyoung
Ahn Hee-Kyung
Shin Seong-Hoon
Kim Hye-Ryun
Kim Sung-Bae
Yun Hwan-Jung
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Abstract
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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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KEYWORD
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Locally advanced head and neck squamous cell carcinoma, Induction chemotherapy, Subsequent treatment
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