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Japanese Journal of Clinical Oncology Advance Access originally published online on August 12, 2006
Japanese Journal of Clinical Oncology 2006 36(9):537-546; doi:10.1093/jjco/hyl081
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© 2006 Foundation for Promotion of Cancer Research

Analysis of Prognostic Variables among Patients with Locally Advanced Head and Neck Cancer Treated with Late Chemo-Intensification Protocol: Impact of Nodal Density and Total Tumor Volume

Kundan S. Chufal1, Madhup Rastogi2, Madhu Srivastava2, M. C. Pant2, M. L. B. Bhatt2 and Kirti Srivastava2

1 Department of Oncology, Batra Hospital and Medical Research Centre, New Delhi and 2 Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India

For reprints and all correspondence: Kundan Singh Chufal, Senior Resident, Department of Oncology, Batra Hospital and Medical Research Centre, 1, Tughlakabad Institutional Area, New Delhi 110062, India. E-mail: kundan_25{at}rediffmail.com

Received April 17, 2006; accepted June 8, 2006

Objective: The aim of the present study was to define the prognostic impact of nodal density (ND) and total tumor volume along with many other tumor, treatment and patient related variables using the late chemo-intensification treatment regimen with conventionally fractionated radiotherapy (70 Gy/7 weeks).

Methods: A total of 74 patients with Stage III and IV biopsy proven squamous cell carcinoma of oropharynx, hypopharynx and larynx were treated with this regimen. ND and total tumor volume was measured on high resolution CT scans for all the patients. Chemotherapy consisted of continuous infusion of 5 FU at 350 mg/m2/day and cisplatin as 1 h infusion at 10 mg/m2/day on days 1–5 of week 6 and 7 of radiotherapy.

Results: Grade III mucositis was present in 48 (64.9%) patients. Overall complete response rate was 77%. At 28 months, locoregional relapse-free survival (LRFS), overall survival (OS) and distant metastases-free survival (DMFS) was 70.8%, 66.9% and 81.9%, respectively. In the final multivariate Cox-regression model tumor stage, ND, primary site and nodal stage were independent variables predicting for LRFS. Similarly AJCC group staging, ND and total treatment volume were found to have significant impact, independently over LRFS.

Conclusions: There is tremendous variation in terms of ND and total tumor volume within AJCC nodal staging and tumor staging, respectively. ND had significant impact over LRFS and OS. Future phase III trial may need stratification on the basis of these variables.

Key Words: head and neck cancer • nodal density • concurrent • total tumor volume • chemoboost


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