A comparison of treatment outcomes by radiochemotherapy and postoperative radiotherapy in locally advanced squamous cell carcinomas of head and neck.

摘要

PURPOSE: To investigate the treatment outcomes by concomitant radiochemotherapy (CHEMORAD), and by surgery and postoperative radiotherapy (PORT) in patients with locally advanced head and neck cancers. METHOD: A retrospective study included all patients with Stage III and IV (except T1-2 N1) diseases between 1989 and 2002 treated with CHEMORAD (163 patients) or PORT (424 patients) at the L'Hotel-Dieu de Quebec. Chemotherapy was realized with Cisplatin (DDP) 100 mg/m(2), d1, d23, and d45 during radiotherapy or weekly DDP 40 mg/m(2) for 6 weeks in case of patients with poor general condition. Neck dissection was performed if residual disease was diagnosed on CHEMORAD. For the PORT group, 410 patients had neck dissection before adjuvant treatment. RESULTS: The 2-year loco-regional control was 82% for CHEMORAD, and 72% for PORT (P = 0.01). The 2-year disease-free survival was 72% for CHEMORAD, and 64% for PORT (P = 0.02). The results were further confirmed by a Cox proportional hazard model. CONCLUSION: The results indicated that CHEMORAD is a better approach than PORT in the management of locally advanced head and neck cancers. Further randomized study will be needed to compare radical CHEMORAD with surgery plus adjuvant CHEMORAD to determine an appropriate treatment in the management of locally advanced head and neck squamous cell carcinomas.