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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Bibliographic Details
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
Online Access:Get full text
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Summary: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.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0229266