Factors Associated with Severe Late Toxicity After Concurrent Chemoradiation for Locally Advanced Head and Neck Cancer: An RTOG Analysis

Authors

Mitchell Machtay, MD, Thomas Jefferson UniversityFollow
Jennifer Moughan, MS, RTOG Headquarters and Statistical Center and the American College of Radiology, PhiladelphiaFollow
Andrew Trotti, MD, Moffitt Cancer Center of University of South Florida, Tampa
Adam S. Garden, MD, MD Anderson Cancer Center, HoustonFollow
Randal S. Weber, MD, MD Anderson Cancer Center, HoustonFollow
Jay S. Cooper, MD, Maimonides Medical Center, New York
Arlene Forastiere, MD, Johns Hopkins University Medical Center, Baltimore
K. Kian Ang, MD, MD Anderson Cancer Center, Houston

Abstract

Purpose

Concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases both local tumor control and toxicity. This study evaluates clinical factors that are associated with and might predict severe late toxicity after CCRT.

Methods

Patients were analyzed from a subset of three previously reported RTOG trials of concurrent chemoradiotherapy for locally advanced SCCHN (RTOG 91-11; 97-03; and 99-14). Severe late toxicity was defined in this secondary analysis as chronic Grade 3-4 pharyngeal/laryngeal toxicity (RTOG/EORTC late toxicity scoring system) and/or requirement for a feeding tube ≥2 years after registration and/or potential treatment-related death (e.g. pneumonia) within 3 years. Case-control analysis was performed, with a multivariable logistic regression model that included pre-treatment and treatment potential factors.

Results

A total of 230 patients were evaluable for this analysis, 99 cases (patients with severe late toxicities) and 131 controls; thus 43% of evaluable patients had a severe late toxicity. On multivariable analysis, significant variables correlated with the development of severe late toxicity were older age (odds ratio 1.05 per year; p = 0.001); advanced T-stage (odds ratio 3.07; p=0.0036); larynx/hypopharynx primary site (odds ratio 4.17; p=0.0041); and neck dissection after chemo-RT (odds ratio 2.39; p=0.018).

Conclusions

Severe late toxicity following CCRT is common. Older age, advanced T-stage, and larynx/ hypopharynx primary site were strong independent risk

American Society of Clinical Oncology. Machtay, M. et al: J. Clin. Oncol. 26 (21), 2008:3582-3589.

Recommended Citation

Machtay, MD, Mitchell; Moughan, MS, Jennifer; Trotti, MD, Andrew; Garden, MD, Adam S.; Weber, MD, Randal S.; Cooper, MD, Jay S.; Forastiere, MD, Arlene; and Ang, MD, K. Kian (2008) "Factors Associated with Severe Late Toxicity After Concurrent Chemoradiation for Locally Advanced Head and Neck Cancer: An RTOG Analysis," Bodine Journal: Vol. 1: Iss. 1, Article 7.
DOI: https://doi.org/10.29046/TBJ.001.1.006
Available at: https://jdc.jefferson.edu/bodinejournal/vol1/iss1/7