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Changing Patterns of Failure of Head and Neck Cancer
Charu Taneja, MD;
Heidi Allen, CTR;
R. James Koness, MD;
Kathy Radie-Keane, MD;
Harold J. Wanebo, MD
Arch Otolaryngol Head Neck Surg. 2002;128:324-327.
Background With the increased use of neoadjuvant therapy for advanced stage squamous
cell carcinoma of the head and neck, we have observed an apparent change in
the pattern of failure from predominantly locoregional sites to distant metastases.
We reviewed the patterns of failure in cancers of the oral cavity, oropharynx,
and larynx at our institution during the last decade.
Objective To determine whether there has been a significant change in the patterns
of recurrence from the historical locoregional failure to distant sites, and
whether this change is associated with the increased use of multimodality
therapy.
Methods We reviewed cancer registry data on patients with squamous cell carcinoma
of the head and neck diagnosed between January 1, 1988, and December 31, 1999.
Sites included the oral cavity and oropharynx (including the tongue, floor
of mouth, retromolar trigone, gingiva, tonsil, and lip) and larynx.
Results Among 432 patients with squamous cell carcinoma of the head and neck,
280 (65%) had oral cavity and oropharyngeal cancers, and 152 (35%) had laryngeal
cancers. Overall, 19% developed locoregional recurrence, and 8% developed
distant failure. Although locoregional failure for oral cavity and oropharyngeal
squamous cell carcinoma decreased from 26% to 16% from 1988-1993 to 1994-1999,
distant failure increased significantly from 3% to 8%. During these periods,
multimodality therapy was used in 62% of oral cavity and oropharyngeal cancers,
and this rate remained essentially unchanged. For laryngeal cancer, locoregional
and distant failure remained stable at 18% and 9%, respectively. In these
laryngeal cancers, the use of multimodality therapy decreased from 60% to
46%, but this difference was not statistically significant (P = .43).
Conclusions Although locoregional control in oral cavity and oropharyngeal cancers
has improved significantly with the use of multimodality therapy, the incidence
of distant failure has doubled. In laryngeal squamous cell carcinoma, the
patterns of failure have not changed significantly.
From the Departments of Surgical Oncology (Drs Taneja, Koness, and
Wanebo, and Ms Allen) and Radiation Oncology (Dr Radie-Keane), Roger Williams
Hospital Tumor Registry (Ms Allen), Roger Williams Medical Center, Providence,
RI.
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