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Analysis of Risk Factors Predictive of Distant Failure After Targeted Chemoradiation for Advanced Head and Neck Cancer
Ilana Doweck, MD;
K. Thomas Robbins, MD;
Francisco Vieira, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1315-1318.
Background Distant metastasis (DM) is the most common mode of recurrence among
patients with advanced head and neck carcinoma treated with intra-arterial
cisplatin and radiotherapy (RADPLAT).
Objective To identify which patients are at greatest risk for DM and would benefit
the most from new strategies designed to treat occult metastases.
Methods Between 1993 and 1999, 250 patients with advanced head and neck cancer
were treated by RADPLAT. Excluded from the analysis were 10 patients who either
did not complete the protocol or were unavailable for follow-up and 39 patients
with persistent disease or local recurrence. The incidence and the risk factors
for DM in these patients were evaluated in a model that included the following
factors: age, T and N classification, site of tumor, histologic grade, number
(0, 1, or >1) and position (high vs low) of neck levels involved, and bilateral
nodal disease. Multiple stepwise logistic regression was used for the analysis.
Results In a univariate analysis, the following variables correlated to DM:
N classification (P = .02), site of tumor (P = .01), lower neck nodes (P
= .002), number of neck levels involved (P = .001),
and bilateral nodal disease (P = .02). In a multivariate
analysis, the most significant risk factors for DM were the number of neck
levels involved and the site of the primary tumor (P<.001).
The highest odds ratios for DM were among patients with multiple levels of
nodal involvement (3.17) and patients with hypopharyngeal carcinoma (2.8).
Conclusions Patients with more than 1 level of clinical nodal involvement and patients
with hypopharyngeal carcinoma have the highest risk of developing DM as the
initial site of failure and would benefit most from treatment strategies that
address occult distant disease.
From the Department of Otolaryngology, Head and Neck Surgery, College
of Medicine, University of Tennessee, Memphis (Drs Doweck, Robbins, and Vieira);
and Department of Otolaryngology, Head and Neck Surgery, University of Florida
College of Medicine, Gainesville (Drs Doweck and Robbins). Dr Doweck is now
with the Department of Otolaryngology, Head and Neck Surgery, Carmel Medical
Center, Haifa, Israel.
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Arch Otolaryngol Head Neck Surg. 2001;127(11):1403-1405.
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