Benefit from surgery with additional radiotherapy in N1 head and neck cancer at the time of IMRT: A population-based study on recent developments

Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together wi...

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Published in:	PloS one Vol. 15; no. 2; p. e0229266
Main Authors:	Evers, Christoph, Ostheimer, Christian, Sieker, Frank, Vordermark, Dirk, Medenwald, Daniel
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 26.02.2020 Public Library of Science (PLoS)
Subjects:	Aged Analysis Cancer Cancer patients Cancer research Cancer therapies Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - radiotherapy Carcinoma, Squamous Cell - surgery Classification Combined Modality Therapy Combined treatment Datasets Disease Diseases Epidemiology Female Follow-Up Studies Head & neck cancer Head and neck cancer Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - radiotherapy Head and Neck Neoplasms - surgery Human papillomavirus Humans Irradiation Lymph nodes Lymphatic system Male Medical diagnosis Medicine and Health Sciences Middle Aged Oncology Operating systems (Software) Papillomavirus infections Patients Population Population studies Population-based studies Prognosis Radiation therapy Radiotherapy Radiotherapy Dosage Radiotherapy, Intensity-Modulated - mortality Regression analysis Retrospective Studies Squamous cell carcinoma Statistical analysis Surgery Survival Survival Rate Tumors Iowa Germany
ISSN:	1932-6203, 1932-6203
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Abstract	Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery.
AbstractList	Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified.BACKGROUNDCurrently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified.To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients.OBJECTIVESTo assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients.We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site).MATERIALS AND METHODSWe used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site).Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03).RESULTSTemporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03).The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery.CONCLUSIONThe advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery. BACKGROUND:Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. OBJECTIVES:To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. MATERIALS AND METHODS:We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). RESULTS:Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). CONCLUSION:The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery. Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery. Background Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. Objectives To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. Materials and methods We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan–Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). Results Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35–0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). Conclusion The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery. Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based effect of recent developments in radiotherapy such as intensity-modulated radiotherapy (IMRT) in relation to overall survival (OS) together with surgery in N1 HNC patients. We used 9,318 HNC cases with pT1/2 N0/1 disease from German cancer registries. Time of diagnosis ranged from January 2000 to December 2014, which we divided into three periods: (low [LIA] vs intermediate [IA] vs high [HIA] IMRT availability period) based on usage of IMRT in Germany. For each period, we examined a possible association between treatment (surgery vs. surgery and radiotherapy) in terms of OS. Statistical analyses included Kaplan-Meier and multivariate Cox regression (models adjusted for HPV-related cancer site). Temporal analysis revealed increasing usage of IMRT in Germany. In patients with N1 tumours, a comparison of patients treated with and without radiotherapy during the HIA period showed a superiority of the combined treatment as opposed to surgery alone (HR 0.54, 95%CI: 0.35-0.85, p = 0.003). The survival analyses related to treatments in terms of period underlined the superiority of surgery plus radiotherapy between periods IA and HIA (p = 0.03). The advent of IMRT, additional radiotherapy may present a survival advantage in patients with N1 HNC when combined with surgery.
Audience	Academic
Author	Evers, Christoph Sieker, Frank Medenwald, Daniel Ostheimer, Christian Vordermark, Dirk
AuthorAffiliation	Chang Gung Memorial Hospital at Linkou, TAIWAN 1 Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany 3 Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany 2 Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Saxony, Germany 4 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
AuthorAffiliation_xml	– name: 1 Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany – name: 2 Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Saxony, Germany – name: 4 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany – name: 3 Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany – name: Chang Gung Memorial Hospital at Linkou, TAIWAN
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CitedBy_id	crossref_primary_10_1186_s13014_023_02249_w crossref_primary_10_3390_cancers15204906 crossref_primary_10_3390_cells9092050 crossref_primary_10_1097_COC_0000000000000792 crossref_primary_10_3390_clinpract14040103 crossref_primary_10_3390_ejihpe13100157 crossref_primary_10_1016_j_ccr_2021_214059
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Snippet	Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based... Background Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. Objectives To assess... Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. To assess the population-based... Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified.BACKGROUNDCurrently, the role of... BACKGROUND:Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. OBJECTIVES:To assess... Background Currently, the role of adjuvant irradiation in head and neck cancer (HNC) patients with N1-lymph node status is not clarified. Objectives To assess...
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SubjectTerms	Aged Analysis Cancer Cancer patients Cancer research Cancer therapies Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - radiotherapy Carcinoma, Squamous Cell - surgery Classification Combined Modality Therapy Combined treatment Datasets Disease Diseases Epidemiology Female Follow-Up Studies Head & neck cancer Head and neck cancer Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - radiotherapy Head and Neck Neoplasms - surgery Human papillomavirus Humans Irradiation Lymph nodes Lymphatic system Male Medical diagnosis Medicine and Health Sciences Middle Aged Oncology Operating systems (Software) Papillomavirus infections Patients Population Population studies Population-based studies Prognosis Radiation therapy Radiotherapy Radiotherapy Dosage Radiotherapy, Intensity-Modulated - mortality Regression analysis Retrospective Studies Squamous cell carcinoma Statistical analysis Surgery Survival Survival Rate Tumors
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Title	Benefit from surgery with additional radiotherapy in N1 head and neck cancer at the time of IMRT: A population-based study on recent developments
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