Overall Survival in Stage III and IV High-Risk Head and Neck Squamous Cell Carcinoma Patients who received Adjuvant Chemotherapy and Radiation without Cisplatin

Abstract

Objectives: Microscopically involved resection margins and/or extracapsular spread represent the most significant prognostic factors for poor outcome in head and neck cancer. Purpose of this study was to estimate overall survival, and assess impact of demographic and clinicopathologic variables on survival in stage III and IV high-risk patients who received chemoradiation other than CisplatinMethods: Retrospective review Results: The final cohort of 18 eligible patients had a median age of 66 years and males were 66.66%. Median survival was 20.5 months. Patients were trichotomized into three age groups for comparison; ≤60 years, 61-70 years, ≥71 years. A superior overall survival was observed with advanced age (HR, 4.02; 95%CI, 1.33-12.17, p=0.016). Overall survival was significantly lower in patients with high Charlson comorbidity scores of 3-8 when compared to those with low scores of 0-2 (HR, 25.6; 95%CI, 2.78-236.7, p=0.0009). Young patients had high comorbidity scores (CCI > 2) based on the age-groups; ≤60 years (60%), 61-70 years (28.57%), ≥71 years (none). Tumor stage, positive resection margins, extracapsular spread, perineural involvement, lymphovascular invasion, tumor grade, high-risk human papillomavirus, body mass index, smoking and alcohol did not affect overall survival significantly.Conclusions: Young age and severe comorbidity should be considered when treating high-risk head and neck cancer squamous cell carcinoma patients with adjuvant chemoradiation therapy other than Cisplatin due to inferior overall survival.