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Similar outcomes observed after radiotherapy in whites, blacks with HNSCC
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Race did not predict outcomes in a cohort of patients with nonmetastatic squamous cell carcinoma of the head and neck who underwent radiotherapy, according to results of a retrospective cohort study.
Researchers reported no differences between blacks and whites with regard to 2-year freedom from distant metastasis, PFS or OS.
Prior studies have suggested black patients with HNSCC experience worse outcomes after radiotherapy. However, these findings were based upon cohorts that included smaller percentages of black patients than white patients.
In the current analysis, researchers evaluated race as a predictor for outcomes in 602 patients with nonmetastatic HNSCC who underwent radiotherapy between 1990 and 2012. The cohort included 366 black patients and 236 white patients.
Locoregional control, freedom from distant metastasis, PFS and OS served as primary outcome measures.
Median follow-up was 18.3 months. Researchers reported a higher 2-year locoregional control rate for black patients (71.9% vs. 64.2%; HR=0.72; P=.03). Similar outcomes were observed when researchers limited the analysis to patients with stage III to stage IVb disease.
Results from multivariate analysis indicated race was not significantly associated with PFS, OS, freedom from distant metastasis or locoregional control.
“Black patients had worse socioeconomic factors and increased comorbidities, but had similar treatment compliance compared with white patients,” the researchers wrote. “The current data suggest that centers that treat large percentages of minority patients who receive radiotherapy for HNSCCs may overcome existing health care disparities through improved treatment compliance.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopBarbara Burtness, MD
Researchers from the University of Illinois studied 602 patients who received radiation for squamous cell carcinoma of the head and neck between 1990 and 2012. The majority of the patients were black, and in this series, black patients did not have the worse outcome that had previously been well documented in other series.
PFS, OS and freedom from metastasis in the University of Illinois series were equivalent for black and non-Hispanic white patients, and the locoregional control described for black patients was actually superior to that for non-Hispanic white patients. The rate of truncation for the radiation course was only 3.3% for black patients, compared with 8.1% for non-Hispanic white patients. These findings are more surprising given higher rates among the black patients of characteristics associated with worse outcome in previous studies, including history of tobacco use, history of alcohol use, living alone, higher comorbidity burden and lower socioeconomic status. Also, fewer black patients had evidence of favorable–prognosis HPV-associated oropharynx cancer.
The authors conclude that, for large referral centers experienced in the care of minority patients, equivalent — and quite good — results can be achieved with radiation for head and neck cancers in black and non-Hispanic white patients. This would be a welcome finding indeed. The rates of treatment completion here — as well as the overall 2-year local control rate of 72% in a group of predominantly HPV-negative, predominantly stage III and IV black patients — is impressive.
Some caution in interpretation of the results is warranted, given the heterogeneity of the cohort and the long length of time over which the cases were accrued. Median follow-up was only 18.3 months. Favorable anatomic subsites, such as larynx and nasopharynx, were more common among black than non-Hispanic white patients, and the proportion receiving IMRT was lower. However, these encouraging results support treatment of advanced head and neck cancers at high-volume centers and provide hope that historical disparities in cancer treatment can be overcome.
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