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Oral Oncol. 2017 Aug;71:61-66. doi: 10.1016/j.oraloncology.2017.06.002. Epub 2017 Jun 9.

Very accelerated radiotherapy or concurrent chemoradiotherapy for N3 head and neck squamous cell carcinoma: Pooled analysis of two GORTEC randomized trials.

Author information

1
Institut Gustave Roussy, Villejuif, France. Electronic address: yungan.TAO@gustaveroussy.fr.
2
Institut Gustave Roussy, Villejuif, France.
3
Centre Claudius Regaud, Toulouse, France.
4
Centre Jean Perrin, Clermont-Ferrand, France.
5
Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium.
6
Centre Georges-François Leclerc, Dijon, France.
7
Centre Alexis Vautrin, Nancy, France.
8
CHU Bretonneau Tours, France.
9
Centre François Baclesse, Caen, France.
10
Centre Guillaume Le Conquérant, Le Havre, France.
11
Clinique Sainte-Catherine, Avignon, France.
12
Clinique d'oncologie Saint-Yves, Vannes, France.
13
Centre René Gauducheau, Nantes, France.
14
Centre Hospitalier Universitaire La Timone, Marseille, France.
15
Centre Hospitalier de Lorient, France.
16
Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Abstract

OBJECTIVE:

To analyze the outcome of N3 patients treated with very accelerated radiotherapy (VART) or different schedules of concurrent chemoradiotherapy (CRT) within two phase III trials.

PATIENTS AND METHODS:

Data of 179 patients with N3 HNSCC from two GORTEC randomized trials (96-01 and 99-02) were pooled. Patients received either VART: 64.8Gy/3.5weeks or one of the 3 following CRT regimens: Conventional CRT: 70Gy/7weeks+3 cycles carboplatin-5FU; Moderately accelerated CRT: 70Gy/6weeks+2 cycles carboplatin-5FU; Strongly intensified CRT: 64Gy/5weeks+cisplatin (days 2, 16, 30) and 5 FU (days 1-5, 29-33) followed by 2 cycles adjuvant cisplatin-5FU.

RESULTS:

Median follow-up was 13.3 and 5.2years for GORTEC 96-01 and GORTEC 99-02, respectively. Five-year overall survival (OS) was 13.8%. No significant difference was observed between CRT versus VART in terms of OS (hazard ratio [HR]: 0.93, p=0.68), loco-regional progression (HR: 0.70, p=0.13), or distant progression (HR: 0.86, p=0.53). OS was worse for patients with T3-4 tumors versus early T stage (11.0% versus 25.7%, p=0.015). In multivariate analysis, the oropharyngeal subsite presented a higher risk of distant metastasis (as first event 46.5% vs 19.2%, p<0.001),). A significant interaction between treatment modalities and subsites has been observed concerning loco-regional and distant failures.

CONCLUSION:

The outcome of N3 HNSCC was extremely poor despite treatment intensification and no difference between CRT and VART. Both distant metastases and loco-regional failures remain important treatment challenge.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00828386.

KEYWORDS:

Accelerated radiotherapy; Concurrent chemoradiotherapy; Distant metastasis; Head and neck cancer; N3; Oropharyngeal cancer

[Indexed for MEDLINE]

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