Ly Do M.D. (1), Morteza Dowlatshahi M.D. (1), Zayd Parekh (2), Richard Trevino (3), Richard Eng M.D. (3), Karen Fann (3), Ngon Dinh (3), Raymond Lee M.D. (4), Charlene Lee M.D. (4), Tin Hla M.D. (4)
- Cancer Care Institute, 200 Jose Figueres Ave #199, San Jose, CA 95116, 2. San Jose State University 3. Department of ENT, Regional Medical Center of San Jose, 200 Jose Figueres Ave, San Jose, CA 95116, 4. Department of Medical Oncology Regional Medical Center of San Jose, 200 Jose Figueres Ave, San Jose, CA 95116
Objectives- LAHNSCC can be treated with concurrent chemoradiation or concurrent radiation with cetuximab. Previous studies have suggested superior outcomes for LAHNSCC treated with radiation and cisplatin versus radiation and cetuximab (1-3). We compared outcomes amongst our cohort of patients who were treated with concurrent radiation therapy (RT) and cisplatin versus concurrent RT and cetuximab in a community hospital setting.
Methods- Retrospective analysis was performed on stage III and IV LAHNSCC patients treated at Cancer Care Institute from 01/97 to 08/17 with cisplatin (n=37) or cetuximab (n=11) with concurrent RT to 7000 cGy using 3DCRT or IMRT with image guidance. Patients included in this study had LAHNSCC of the oropharynx, hypopharynx, larynx, and oral cavity. Patient’s with metastatic disease at presentation were excluded. LRC, OS, and distant metastasis-free survival survival were then analyzed using the Kaplan Meier Method and Cox analysis tools.
Results- 3-year LRC for concurrent chemoradiation was 100% vs. 42% for cetuximab and radiation (P < 0.0001). OS was found to be non-significantly different with 5-year OS of concurrent chemoradiation to be at 56% vs. 48%; for cetuximab and radiation (P = 0.6). 3 patients in the cetuximab treated group had successful salvage treatment with surgical resection. 2/3 of these patients required total laryngectomies. None of the patients treated with chemoradiation required salvage therapy. 2-year organ preservation rate for concurrent chemoradiation was 100% vs. 87.5% for cetuximab and radiation (P = 0.0047).
Conclusions- The data obtained from this retrospective analysis adds to a growing body of literature that suggests that RT with concurrent cisplatin may yield superior outcomes in comparison to concurrent cetuximab (1-3). In addition, our data suggests a higher quality of life with improved organ preservation rates associated with chemoradiation. Randomized phase III trials should be performed to validate these findings.