Comparison between exclusive (chemo)radiation and surgery or induction chemotherapy as first curative treatment for localized or locally advanced head and neck squamous cell carcinomas (L(A)-HNSCC): Sub-analysis of the EPOCKS study

Abstract

Background: The initial curative standard treatment for LAHNSCC is exclusive CRT (chemoradiotherapy) or surgery ( ​± ​CRT) which give similar results in term of PFS and OS. Indication depends on several factors including regional expertise and anticipated sequela. The role of induction chemotherapy (IC) remains questionable to this day. Previous publications suggested that surgery followed by CRT could be relevant for high-risk tumors. The aim of this retrospective study was to compare (C)RT to alternative approaches (S/IC: surgery and/or IC±CRT). Methods: 1120 patients (pts) with a LAHNSCC treated for the first time in 1998, 2004 or 2006 were retrospectively analyzed and 977 were finally evaluable. Pts were distributed according to their first curative treatment: (C)RT or S/IC. Overall (OS) and progression-free survival (PFS) were compared using Kaplan-Meier analyses. OS and PFS were calculated from the start date of treatment. Results: With a median follow-up of 3.3 years (95% IC 3.0–3.6), 335 ​pts died and the median PFS was 4.0 years in the whole population. A statistically significant lower PFS (HR ​= ​0.79; CI95% [0.63–0.99]; p ​= ​0.0439) and lower OS (HR ​= ​0.67; CI95% [0.51–0.87]; p ​= ​0.0023) were observed with CRT group compared to S/IC group (adjusted for the variables T and N stage and age at diagnosis). Weekly and tri-weekly cisplatin received as potentiation of RT were also explored for the 200 ​pts receiving platin. No difference in PFS or OS was observed but statistical power is weak. Conclusions: This large retrospective study suggests that the standard (C)RT for LASCCHN could be optimized by adding initial surgery or/and IC. Randomized trials are warranted to conclude.