Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Appropriate selection of head and neck cancer (HNC) patients for curative versus palliative treatment is one of the most difficult clinical decisions. The aims of this study were to 1) review the outcomes of curative intent treatment of HNC patients with borderline curability, and 2) assess the utility of a previously devised patient selection algorithm for curative treatment.
Materials/Methods: A single institution retrospective review of patients with mucosal squamous cell carcinoma treated with curative intent between January 1 2004 and December 31 2011. Criteria for borderline curability included one or more of;1) T4 and/or N3 disease; 2) ECOG performance status >/=2; 3) age >/=80 years.
Results: 199 patients were identified. 137 had T4/N3 disease, 48 were >/=80 years, and 40 were >/= ECOG 2. Overall survival (OS) at 2 and 5 years was 67% (95% CI:60-74) and 45% (95% CI: 39-53) respectively. The 2- and 5-year progression free survival (PFS) were 62% (95% CI: 55-69) and 39% (95% CI: 33-47), respectively. On multivariate analysis, independent predictive factors for overall survival were adult comorbidity evaluation-27 (ACE-27) grade and ECOG status. 33 of the 199 patients should not have received curative intent treatment according to the algorithm. These patients had significantly poorer treatment completion rates and OS and PFS.
Conclusion: ACE-27 and ECOG status are a strong and independent prognostic factors for survival among HNC patients of borderline curability. Our patient selection algorithm seems a useful tool to appropriately select patient who are borderline for curative (chemo)radiation treatment.
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