Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

<p class="first" id="d657841e323">This study examines the association of adjuvant radiation therapy vs surgery alone with survival in patients with advanced cutaneous squamous cell carcinoma and assesses which patients benefit the most from addition of adjuvant therapy to surgical treatment. </p><div class="section"> <a class="named-anchor" id="ab-ooi180099-1">  </a> <h5 class="section-title" id="d657841e329">Question</h5> <p id="d657841e331">Is there an association between adjuvant radiation therapy and survival in patients with advanced cutaneous squamous cell carcinoma, and which patients benefit the most from addition of adjuvant therapy to surgical treatment? </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-2">  </a> <h5 class="section-title" id="d657841e334">Findings</h5> <p id="d657841e336">In this multi-institutional study of 349 patients with advanced cutaneous squamous cell carcinoma, adjuvant radiation therapy was associated with improved disease-free survival and overall survival in patients with perineural invasion and regional adenopathy. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-3">  </a> <h5 class="section-title" id="d657841e339">Meaning</h5> <p id="d657841e341">The findings suggest that patients with perineural invasion and regional disease benefit the most from addition of adjuvant radiation therapy to surgical treatment. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-4">  </a> <h5 class="section-title" id="d657841e345">Importance</h5> <p id="d657841e347">Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-5">  </a> <h5 class="section-title" id="d657841e350">Objective</h5> <p id="d657841e352">To assess indications for adjuvant radiation therapy in patients with CSCC.</p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-6">  </a> <h5 class="section-title" id="d657841e355">Design, Setting, and Participants</h5> <p id="d657841e357">Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-7">  </a> <h5 class="section-title" id="d657841e360">Main Outcomes and Measures</h5> <p id="d657841e362">Data were compared between treatment groups with a χ <sup>2</sup> analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-8">  </a> <h5 class="section-title" id="d657841e368">Results</h5> <p id="d657841e370">A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180099-9">  </a> <h5 class="section-title" id="d657841e373">Conclusions and Relevance</h5> <p id="d657841e375">Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease. </p> </div>

Related collections

Most cited references 19

Record: found
Abstract: found
Article: not found

Incidence estimate of nonmelanoma skin cancer in the United States, 2006.

Howard W Rogers, Martin Weinstock, Ashlynne R. Harris … (2010)

To estimate the incidence of nonmelanoma skin cancer (NMSC) in the US population in 2006 and secondarily to indicate trends in numbers of procedures for skin cancer treatment. A descriptive analysis of population-based claims and US Census Bureau data combined with a population-based cross-sectional survey using multiple US government data sets, including the Centers for Medicare and Medicaid Services Fee-for-Service Physicians Claims databases, to calculate totals of skin cancer procedures performed for Medicare beneficiaries in 1992 and from 1996 to 2006 and related parameters. The National Ambulatory Medical Care Service database was used to estimate NMSC-related office visits. We combined these to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 76.9% from 1 158 298 in 1992 to 2 048 517 in 2006. The age-adjusted procedure rate per year per 100 000 beneficiaries increased from 3514 in 1992 to 6075 in 2006. From 2002 to 2006 (the years for which the databases allow procedure linkage to patient demographics and diagnoses), the number of procedures for NMSC in the Medicare population increased by 16.0%. In this period, the number of procedures per affected patient increased by 1.5%, and the number of persons with at least 1 procedure increased by 14.3%. We estimate the total number of NMSCs in the US population in 2006 at 3 507 693 and the total number of persons in the United States treated for NMSC at 2 152 500. The number of skin cancers in Medicare beneficiaries increased dramatically over the years 1992 to 2006, due mainly to an increase in the number of affected individuals. Using nationally representative databases, we provide evidence of much higher overall totals of skin cancer diagnoses and patients in the US population than previous estimates. These data give the most complete evaluation to date of the underrecognized epidemic of skin cancer in the United States.

0 comments Cited 250 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study.

Chrysalyne D Schmults, Pritesh S Karia, Joi B Carter … (2013)

Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968.

0 comments Cited 136 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years.

Mark A Weaver, Theresa A Borrowman, Clark Otley … (2005)

The incidence of nonmelanoma skin cancer is increasing rapidly among elderly persons, but little is known about its incidence in the population younger than 40 years. To estimate the sex- and age-specific incidences of basal cell carcinoma and squamous cell carcinoma in persons younger than 40 years in Olmsted County, Minnesota, and to evaluate change in incidence over time; to describe the clinical presentation, rate of recurrence and metastasis, and histologic characteristics of these tumors in this population-based sample. Population-based retrospective incidence case review. Residents of Olmsted County, Minnesota, a population with comprehensive medical records captured through the Rochester Epidemiology Project. Patients younger than 40 years with basal cell carcinoma or squamous cell carcinoma diagnosed between 1976 and 2003. Incident basal cell carcinomas and squamous cell carcinomas and change in incidence of these tumors over time. During the study period, 451 incident basal cell carcinomas were diagnosed in 417 patients and 70 incident squamous cell carcinomas were diagnosed in 68 patients. Of these tumors, 328 were histologically confirmed basal cell carcinomas and 51 were histologically confirmed squamous cell carcinomas. Overall, the age-adjusted incidence of basal cell carcinoma per 100,000 persons was 25.9 (95% confidence interval [CI], 22.6-29.2) for women and 20.9 (95% CI, 17.8-23.9) for men. The incidence of basal cell carcinoma increased significantly during the study period among women (P<.001) but not men (P = .19). Nodular basal cell carcinoma was the most common histologic subtype; 43.0% of tumors were solely nodular basal cell carcinoma and 11.0% had a mixed composition, including the nodular subtype. The incidence of squamous cell carcinoma was similar in men and women, with an average age- and sex-adjusted incidence per 100 000 persons of 3.9 (95% CI, 3.0-4.8); the incidence of squamous cell carcinoma increased significantly over the study period among both women (P = .01) and men (P = .04). This population-based study demonstrated an increase in the incidence of nonmelanoma skin cancer among young women and men residing in Olmsted County, Minnesota. There was a disproportionate increase in basal cell carcinoma in young women. This increase may lead to an exponential increase in the overall occurrence of nonmelanoma skin cancers over time as this population ages, which emphasizes the need to focus on skin cancer prevention in young adults.