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RTOG 9911: Prognostic stratification possible in SCCHN patients
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Certain patient and tumor characteristics have been identified as having prognostic effect in patients with head and neck squamous cell carcinoma who underwent re-irradiation and concurrent systemic therapy as part of the RTOG 9911 trial.
Navesh Sharma, DO, PhD, senior resident in the department of radiation oncology at Fox Chase Cancer Center, Philadelphia, presented the secondary analysis of a phase-2 multi-institutional trial.
Patients with locally recurrent or new second SCCHN typically have low survival rates with survival times of about eight months to 10 months with chemotherapy alone, according to researchers.
RTOG 9911 studied the use of low-dose paclitaxel and cisplatin in combination with split-course concomitant re-irradiation twice a day in locally recurrent or second SCCHN. The median survival time was 12.1 months.
In this secondary analysis of trial results, the researchers performed a recursive partitioning analysis to determine if patients could be divided into risk subgroups based on primary therapy, and patient and tumor characteristics.
Median follow-up was two years; 75 of 99 patients died. Researchers were able to stratify patients into low-, intermediate- and high-risk groups.
The low-risk group was defined as patients aged younger than 70 years with a performance status of zero with an interval one year or longer since completing prior radiation therapy.
The intermediate-risk group was patients aged younger than 70 years with an interval less than one year since completing prior radiotherapy, or patients aged younger than 70 years with a performance status of one and with an interval one year or longer since completing prior radiotherapy. The high-risk group of patients were all those aged 70 years or older.
The one-year OS was 84% in the low-risk group, 45% in the intermediate-risk group and 13% in the high-risk group. When compared with patients in the low-risk group, patients in the intermediate-risk group had a HR of 1.9 (95% CI, 1.1-3.4), and patients in the high-risk group had an HR of 6.1 (95% CI, 2.9-13.0).
“These results suggest that patients in the favorable-risk group could be candidates for aggressive chemo-reirradiation strategies, whereas alternative therapeutic options for older patients may need to be explored. As with any findings associated with a smaller data set, prospective evaluation in a much larger data set is warranted,” Sharma said during the presentation.
For more information:
- Sharma NK. #7.