Decrease in treatment intensity predicts worse outcome in patients with locally advanced head and neck squamous cell...

Area of Science:

• Oncology
• Head and Neck Cancer
• Radiochemotherapy

Background:

• Radiochemotherapy (RCT) is a standard treatment for locally advanced head and neck squamous cell carcinoma (LA-HNSCC).
• Treatment-related toxicities frequently necessitate dose modifications, potentially impacting patient outcomes.

Purpose of the Study:

• To examine the relationship between RCT toxicities, subsequent therapy modifications, and short- and long-term treatment outcomes in LA-HNSCC patients.
• To determine optimal strategies for managing treatment-related toxicities during RCT.

Main Methods:

• A retrospective study of 193 LA-HNSCC patients treated with RCT (70 Gy + platinum agent) between 2010 and 2018.
• Analysis of Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 toxicities and modifications to radiotherapy and chemotherapy schedules.
• Evaluation of associations between toxicity management and objective response rates, progression-free survival, and overall survival.

Main Results:

• 41% of patients experienced at least one grade ≥3 toxicity during RCT.
• Radiotherapy dose reductions occurred in 6% of patients, while 64% had chemotherapy modifications.
• Radiotherapy modifications were linked to significantly lower objective response rates (55% vs. 88%) and 5-year progression-free survival (20% vs. 50%) compared to no modifications (p<0.001).
• Chemotherapy modifications showed no significant impact on response rates or survival.

Conclusions:

• Reductions in radiotherapy dose during RCT for LA-HNSCC are associated with poorer long-term outcomes.
• Modifications to chemotherapy intensity, rather than radiotherapy dose, appear to be a safer approach for managing treatment toxicities.
• Clinical management of RCT toxicities should prioritize chemotherapy adjustments to preserve treatment efficacy and improve patient survival.