1. 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).
- Author
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Lee YG, Kang EJ, Keam B, Choi JH, Kim JS, Park KU, Lee KE, Kim HJ, Lee KW, Kim MK, Ahn HK, Shin SH, Kim HR, Kim SB, and Yun HJ
- Subjects
- Adult, Aged, Cisplatin therapeutic use, Docetaxel therapeutic use, Drug Resistance, Neoplasm, Female, Fluorouracil therapeutic use, Follow-Up Studies, Humans, Induction Chemotherapy methods, Male, Middle Aged, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Head and Neck Neoplasms drug therapy, Squamous Cell Carcinoma of Head and Neck drug therapy
- Abstract
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.
- Published
- 2022
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