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Title: Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy

Abstract

Purpose: To validate the recursive partitioning analysis (RPA) classification system for squamous cell head and neck cancer as recently reported by the VU University Medical Center. Methods and Materials: In eight Dutch head and neck cancer centers, data necessary to classify patients according to the RPA system were retrospectively collected from the charts of a group of 780 patients treated between 1989 and 2003. The patients in this validation group were classified according to the RPA classification system. For each endpoint, the 5-year values and hazard ratios were calculated and compared with the results of the VU University Medical Center. The RPA classification system was considered valid if the hazard ratio of the validation population was within the 95% confidence interval of the VU University Medical Center study population. Results: The locoregional control rate was 82%, 75%, and 63% at 5 years for those with class I, II, and III, respectively (p < 0.0001). The hazard ratio for the locoregional control rate relative to class I was 1.44 (95% confidence interval, 0.97-2.16) for class II and 2.37 (95% confidence interval, 1.57-3.57) for class III. Similar results were found for the distant metastasis, overall survival, and disease-free survival rates. Conclusion: Themore » RPA classification system for head and neck squamous cell carcinoma in the postoperative setting, which was originally designed at one center, proved to be valid in a multicenter setting among patients included in a national multicenter study. This validated RPA classification scheme can be used to assess standard treatment strategies for head and neck squamous cell carcinoma in the postoperative setting, as well as in the design of future prospective studies.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10]
  1. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)
  2. Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands)
  3. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)
  4. Department of Radiation Oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam (Netherlands)
  5. MAASTRO Clinic, Maastricht (Netherlands)
  6. Radiotherapy Institute Friesland, Leeuwarden (Netherlands)
  7. Arnhem Radiotherapy Institute, Arnhem (Netherlands)
  8. Department of Radiation Oncology, Leiden University Medical Center, Leiden (Netherlands)
  9. Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam (Netherlands)
  10. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands). E-mail: j.a.langendijk@rt.umcg.nl
Publication Date:
OSTI Identifier:
20951622
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.12.002; PII: S0360-3016(06)03599-1; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CLASSIFICATION; HEAD; METASTASES; NECK; PATIENTS; RADIOTHERAPY; SURGERY; VALIDATION

Citation Formats

Jonkman, Anja, Kaanders, Johannes, Terhaard, Chris H.J., Hoebers, Frank J.P., Ende, Piet L.A. van den, Wijers, Oda B., Verhoef, Lia C.G., Jong, Martin A. de, Leemans, C. Rene, and Langendijk, Johannes A. Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.12.002.
Jonkman, Anja, Kaanders, Johannes, Terhaard, Chris H.J., Hoebers, Frank J.P., Ende, Piet L.A. van den, Wijers, Oda B., Verhoef, Lia C.G., Jong, Martin A. de, Leemans, C. Rene, & Langendijk, Johannes A. Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy. United States. doi:10.1016/j.ijrobp.2006.12.002.
Jonkman, Anja, Kaanders, Johannes, Terhaard, Chris H.J., Hoebers, Frank J.P., Ende, Piet L.A. van den, Wijers, Oda B., Verhoef, Lia C.G., Jong, Martin A. de, Leemans, C. Rene, and Langendijk, Johannes A. Tue . "Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy". United States. doi:10.1016/j.ijrobp.2006.12.002.
@article{osti_20951622,
title = {Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy},
author = {Jonkman, Anja and Kaanders, Johannes and Terhaard, Chris H.J. and Hoebers, Frank J.P. and Ende, Piet L.A. van den and Wijers, Oda B. and Verhoef, Lia C.G. and Jong, Martin A. de and Leemans, C. Rene and Langendijk, Johannes A.},
abstractNote = {Purpose: To validate the recursive partitioning analysis (RPA) classification system for squamous cell head and neck cancer as recently reported by the VU University Medical Center. Methods and Materials: In eight Dutch head and neck cancer centers, data necessary to classify patients according to the RPA system were retrospectively collected from the charts of a group of 780 patients treated between 1989 and 2003. The patients in this validation group were classified according to the RPA classification system. For each endpoint, the 5-year values and hazard ratios were calculated and compared with the results of the VU University Medical Center. The RPA classification system was considered valid if the hazard ratio of the validation population was within the 95% confidence interval of the VU University Medical Center study population. Results: The locoregional control rate was 82%, 75%, and 63% at 5 years for those with class I, II, and III, respectively (p < 0.0001). The hazard ratio for the locoregional control rate relative to class I was 1.44 (95% confidence interval, 0.97-2.16) for class II and 2.37 (95% confidence interval, 1.57-3.57) for class III. Similar results were found for the distant metastasis, overall survival, and disease-free survival rates. Conclusion: The RPA classification system for head and neck squamous cell carcinoma in the postoperative setting, which was originally designed at one center, proved to be valid in a multicenter setting among patients included in a national multicenter study. This validated RPA classification scheme can be used to assess standard treatment strategies for head and neck squamous cell carcinoma in the postoperative setting, as well as in the design of future prospective studies.},
doi = {10.1016/j.ijrobp.2006.12.002},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 68,
place = {United States},
year = {Tue May 01 00:00:00 EDT 2007},
month = {Tue May 01 00:00:00 EDT 2007}
}
  • Purpose: The local-regional control rate for advanced head-and-neck squamous cell carcinoma (HNSCC) remains poor and is unpredictable for a given individual. This study examined whether gene expression patterns developed from tumors from surgicopathologic, criteria-defined, high-risk HNSCC patients could be correlated with clinical outcomes, namely, metastasis or nonrecurrent disease. Methods and Materials: Fifteen primary tumors from patients treated with a consistent protocol of surgery followed by radiotherapy were examined. Seven of these tumors were from high-risk patients who developed distant metastasis (DM), and eight tumors were from patients with no recurrence (NR) (median follow-up, 59 months). Results: Unsupervised clustering of genemore » expression did not separate the two groups from one another, but when supervised methodologies were applied, 205 genes discriminated the two groups. Within the DM group, genes associated with cell growth and proliferation; DNA replication, recombination, and repair; antiapoptotic pathways; cell adhesion; and angiogenesis were identified. For NR samples, discriminatory genes were associated with the onset of apoptosis. Conclusions: Our data suggest that gene expression analysis of surgically excised HNSCC tumors from patients considered at high risk for recurrence has the potential to identify individuals susceptible to metastasis on the basis of distinct gene-expression patterns. These patients would be ideal candidates for testing systemic therapy.« less
  • Purpose: To investigate, in a multicenter study, the tolerance of induction chemotherapy (ICT) and external radiotherapy (ERT) with concomitant cetuximab in the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN). Patients and Methods: Clinical data from 46 patients with Stage III or IV nonmetastatic SCCHN who received docetaxel, cisplatin, and 5-fluorouracil as ICT, followed by ERT with concomitant cetuximab, were retrospectively analyzed. Clinical safety (weight, allergy, mucositis, and dermatitis) and paraclinical safety (levels of hemoglobin, polynuclear neutrophils, and creatinine clearance) were studied. The primary objective was the proportion of patients who completed the protocol. Results:more » The percentage of patients completing ICT was 73.9%, ERT 93.5%, and cetuximab 69.6%. Induction chemotherapy was better tolerated than that previously reported. The rates of temporary suspensions of radiation (39.1%, mean duration of 13 days) and hospitalization (26.1%) during ERT with concomitant cetuximab were high. Weight loss during treatment (21.4% of patients lost >10% of their body weight), radiodermatitis, and radiomucositis were the main causes of temporary suspension of treatment, although Grade 4 dermatitis was not experienced. There were no allergic reactions to cetuximab. Conclusion: The completed protocol rate for SCCHN patients receiving ICT and ERT with concomitant cetuximab is high and the toxicity acceptable. Future improvements to protocol will be possible through early action and systematic implementation of nutritional support coupled with antibiotic treatment upon the first signs of radiodermatitis. These data could be useful for prospective studies on the safety and efficacy of this protocol.« less
  • Forty-one patients with unresectable Stage IV head and neck squamous cell carcinoma were treated with combined modality therapy (CM) consisting of induction chemotherapy followed by surgery and/or radiotherapy (RT). Treatment and survival results are reported and compared to results obtained in treating 41 historic controls with RT alone. No patient had distant metastases. Patients in the CM group received cis-platinum (DDP) 120 mg/m/sup 2/ on days 1 and 22 with prehydration and mannitol diuresis and bleomycin 15 ..mu../m/sup 2/ as a continuous infusion between days 3-9 started after a 15 ..mu../m/sup 2/ IV push. Patients underwent reendoscopy two weeks aftermore » completing chemotherapy to evaluate response. Subsequent surgery and/or radiotherapy were administered depending on tumor resectability after chemotherapy. Induction chemotherapy with DDP and bleomycn infusion followed by surgery and/or radiotherapy appears to be associated with a higher CR rate and prolonged survival compared to RT alone. (JMT)« less
  • Purpose: The aim of this study was to investigate the prognostic significance of epidermal growth factor (EGFr) expression in oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery and postoperative radiotherapy. Methods and Materials: This retrospective study included 165 OCSCC patients. The expression of EGFr was assessed on paraffin-embedded tissue of the primary tumor by immunohistochemistry using a monoclonal antibody directed against EGFr. Intensity of the EGFr expression was scored by two authors blinded for the clinical outcome. Results: In the univariate analysis, locoregional control at 3 years (LRC) in the EGFr-negative cases was 69% compared with 77% inmore » the EGFr-positive cases (p 0.22). In the multivariate analysis for local control, a significant interaction was found between EGFr and overall treatment time of radiation (OTT). After stratification for EGFr expression, the OTT was of no importance in the EGFr-negative cases, whereas a significant difference in LRC was found in the EGFr-positive cases, in which the LRC after 3 years was 69% and 94% in case of an OTT of 0-42 days and >42 days, respectively (p = 0.009; hazard ratio = 3.42; 95% confidence interval, 1.28-8.96). No significant association was found between EGFr expression and overall survival. Conclusions: In the present study, no association was found between EGFr expression and outcome regarding locoregional control and overall survival. However, the results of the present study suggest that patients with squamous cell carcinoma of the oral cavity with high EGFr expression benefit more from a reduction of the overall treatment time of postoperative radiation than those with low EGFr expression.« less
  • A prospective clinical trial was designed to evaluate efficacy, toxicity, and patient compliance of concomitant postoperative radiotherapy and Cisplatin infusion in patients with Stage III or IV S.C.C. of the head and neck and histological evidence of extra-capsular spread of tumor in lymph node metastase(s). Cisplatin 50 mg IV with forced hydration was given or not every week (i.e., 7 to 9 cycles) concurrently with radiotherapy. Between 1984 and 1988, 83 patients were randomized: 44 were treated by irradiation without chemotherapy (RT group) and 39 by the combined modality (CM group). There was no significant difference between the two groupsmore » in terms of patient characteristics, primary sites, tumor differentiation, T.N. stages, or postoperative prognostic factors. All patients completed the planned radiotherapy. There were seven severe toxicities (greater than grade 3) in the RT group. In the CM group, 30 severe toxicities occurred in 16/39 (41%) patients but none was life-threatening. Seven of 39 (18%) patients received less than two-thirds of the scheduled Cisplatin courses because of intolerance, mainly nausea and vomiting. Preliminary results show a better disease-free survival for the CM group (65% at 24 months) than for the RT group (41% at 24 months). This significant difference is largely due to increased loco-regional control in the CM group (79% vs 59%), the actuarial distant metastasis rates in patients controlled above the clavicles not being statistically different in the two groups.« less