1Department of Radiation Oncology, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
2Department of Radiation Oncology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
3Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
4Department of Otolaryngology-Head and Neck Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
6Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
7Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Seoul, Korea
8Department of Radiation Oncology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
9Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
10Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
11Department of Radiation Oncology, Pusan National University School of Medicine, Busan, Korea
12Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
13Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
14Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Copyright © 2016 by the Korean Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Values are presented as number (%) unless otherwise indicated. CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm; SD, standard deviation; ECOG PS, Eastern Cooperative Oncology Group performance status; WHO, World Health Organization; AJCC, American Joint Committee on Cancer; RT, radiation therapy; IMRT, intensity-modulated radiotherapy; F, 5-fluorouracil; P, cisplatin; N/A, not assessed.
Characteristic | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
CRT (n=380) | NCT (n=188) | p-value | CRT (n=150) | NCT (n=150) | p-value | |
Sex | ||||||
Male | 266 (70.0) | 144 (76.6) | 0.099 | 111 (74.0) | 111 (74.0) | > 0.999 |
Female | 114 (30.0) | 44 (23.4) | 39 (26.0) | 39 (26.0) | ||
Age | ||||||
Median (range, yr) | 52 (19-86) | 50 (20-73) | 0.223 | 51.5 (19-77) | 50 (19-72) | 0.648 |
Mean±SD | 51.4±13.1 | 50.0±12.1 | 50.8±13.2 | 50.5±11.6 | ||
ECOG PS | ||||||
0 | 65 (17.1) | 34 (18.1) | 0.539 | 27 (18.0) | 25 (16.7) | 0.963 |
1 | 303 (79.7) | 151 (80.3) | 119 (79.3) | 122 (81.3) | ||
2 | 12 (3.2) | 3 (1.6) | 4 (2.7) | 3 (2.0) | ||
WHO histology | ||||||
I | 77 (20.3) | 17 (9.0) | < 0.001 | 15 (10.0) | 17 (11.3) | 0.502 |
IIa | 108 (28.4) | 75 (39.9) | 59 (39.3) | 58 (38.7) | ||
IIb | 187 (49.2) | 84 (44.7) | 70 (46.7) | 71 (47.3) | ||
Not classified | 8 (2.1) | 12 (6.4) | 6 (4.0) | 4 (2.7) | ||
T stage | ||||||
1 | 95 (25.0) | 54 (28.7) | 0.308 | 38 (25.3) | 40 (26.7) | 0.389 |
2 | 102 (26.8) | 39 (20.7) | 34 (22.7) | 34 (22.7) | ||
3 | 86 (22.6) | 39 (20.7) | 36 (24.0) | 35 (23.3) | ||
4 | 97 (25.5) | 56 (29.8) | 42 (28.0) | 41 (27.3) | ||
N stage | ||||||
0 | 44 (11.6) | 16 (8.5) | 0.366 | 15 (10.0) | 13 (8.7) | 0.410 |
1 | 104 (27.4) | 50 (26.6) | 42 (28.0) | 41 (27.3) | ||
2 | 172 (45.3) | 98 (52.1) | 71 (47.3) | 75 (50.0) | ||
3 | 60 (15.8) | 24 (12.8) | 22 (14.7) | 21 (14.0) | ||
AJCC stage | ||||||
II | 38 (10.0) | 13 (6.9) | 0.480 | 14 (9.3) | 12 (8.0) | 0.914 |
III | 194 (51.1) | 99 (52.7) | 77 (51.3) | 79 (52.7) | ||
IV | 148 (38.9) | 76 (40.4) | 59 (39.3) | 59 (39.3) | ||
Hospital size | ||||||
Large | 264 (69.5) | 104 (55.3) | 0.001 | 97 (64.7) | 93 (62.0) | 0.637 |
Small | 116 (30.5) | 84 (44.7) | 53 (35.3) | 57 (38.0) | ||
RT method | ||||||
Non-IMRT | 231 (60.8) | 63 (33.5) | < 0.001 | 52 (34.7) | 57 (38.0) | 0.456 |
IMRT | 149 (39.2) | 125 (66.5) | 98 (65.3) | 93 (62.0) | ||
CRT regimen | ||||||
Cisplatin alone | 322 (84.7) | 159 (84.6) | 0.883 | 131 (87.3) | 126 (84.0) | 0.411 |
Combined | 58 (15.3) | 29 (15.4) | 19 (12.7) | 24 (16.0) | ||
NCT regimen | ||||||
FP | - | 36 (19.1) | N/A | - | 32 (21.3) | N/A |
F or P+taxane | - | 64 (34.0) | - | 61 (40.7) | ||
FP+taxane | - | 78 (41.4) | - | 48 (32.0) | ||
Other | - | 10 (5.3) | - | 9 (6.0) |
Factor | Overall survival |
Disease-free survival |
Locoregional failure-free survival |
Distant failure-free survival |
||||
---|---|---|---|---|---|---|---|---|
Adjust HR | p-value | Adjust HR | p-value | Adjust HR | p-value | Adjust HR | p-value | |
Treatment arm (CRT vs. NCT) | 0.74 (0.53-1.30) | 0.297 | 1.02 (0.70-1.47) | 0.939 | 2.21 (1.19-4.12) | 0.012 | 0.84 (0.52-1.38) | 0.844 |
Sex (male vs. female) | 1.46 (0.7-2.75) | 0.246 | 0.90 (0.58-1.41) | 0.648 | 1.25 (0.65-2.42) | 0.503 | 0.61 (0.31-1.18) | 0.140 |
Age (< 60 yr vs. ≥ 60 yr) | 1.02 (1.00-1.05) | 0.087 | 1.01 (0.99-1.03) | 0.258 | 1.03 (1.00-1.05) | 0.069 | 1.00 (0.98-1.02) | 0.841 |
ECOG PS (0-1 vs. 2) | 0.63 (0.08-4.91) | 0.662 | 1.26 (0.45-3.55) | 0.662 | 2.13 (0.48-9.48) | 0.319 | 0.92 (0.22-3.90) | 0.913 |
WHO histology (I vs. II) | 1.32 (0.55-3.19) | 0.535 | 1.21 (0.68-2.15) | 0.528 | 1.10 (0.45-2.67) | 0.830 | 1.81 (0.76-4.30) | 0.180 |
T stage (1-2 vs. 3-4) | 2.54 (1.38-4.70) | 0.003 | 2.28 (1.53-3.39) | < 0.001 | 2.16 (1.16-4.01) | 0.015 | 2.11 (1.26-3.53) | 0.005 |
N stage (0-1 vs. 2-3) | 1.56 (0.85-2.89) | 0.153 | 2.00 (1.30-3.08) | 0.002 | 1.47 (0.76-2.82) | 0.252 | 2.30 (1.29-4.10) | 0.005 |
RT method (non-IMRT vs. IMRT) | 0.93 (0.52-1.69) | 0.819 | 1.00 (0.67-1.49) | 0.996 | 0.99 (0.53-1.85) | 0.970 | 0.94 (0.56-1.58) | 0.821 |
Factor (CRT vs. NCT arm) | Overall survival |
Disease-free survival |
Locoregional failure-free survival |
Distant failure-free survival |
||||
---|---|---|---|---|---|---|---|---|
Adjust HR | p-value | Adjust HR | p-value | Adjust HR | p-value | Adjust HR | p-value | |
Age | ||||||||
< 60 yr (116 vs. 110) | 0.78 (0.38-1.58) | 0.486 | 0.79 (0.50-1.24) | 0.302 | 1.48 (0.69-3.19) | 0.314 | 0.64 (0.36-1.15) | 0.138 |
≥ 60 yr (44 vs. 40) | 0.80 (0.32-2.02) | 0.804 | 1.65 (0.85-3.21) | 0.138 | 4.04 (1.33-12.26) | 0.014 | 1.48 (0.58-3.76) | 0.407 |
AJCC stage | ||||||||
II-III (91 vs. 91) | 0.45 (1.67-1.21) | 0.116 | 1.28 (0.74-2.19) | 0.378 | 3.34 (1.33-8.37) | 0.010 | 1.06 (0.53-2.11) | 0.873 |
IV (59 vs. 59) | 1.08 (0.53-2.16) | 0.840 | 0.80 (0.47-1.34) | 0.390 | 1.49 (0.62-3.57) | 0.377 | 0.54 (0.27-1.09) | 0.088 |
Age < 60 yr and AJCC stage IV (44 vs. 46) | 0.81 (0.33-2.02) | 0.652 | 0.56 (0.30-1.02) | 0.058 | 1.06 (0.36-3.08) | 0.918 | 0.46 (0.21-0.99) | 0.049 |
Type of treatment | CRT (n=380) | NCT (n=188) | p-value |
---|---|---|---|
Radiation interruption | 7 (1.8) | 8 (4.3) | 0.091 |
Duration, mean (range, day) | |||
Entire cohort | 53.5 (17-165) | 52.8 (13-158) | 0.621 |
PSM cohort | 50.0 (31-98) | 53.9 (34-117) | 0.018 |
Chemotherapy during CRT | |||
Total interruption | 61 (16.1) | 33 (17.6) | 0.651 |
Cisplatin weekly | |||
1-4 cycles | 24 (18.8) | 23 (21.9) | 0.550 |
≥ 5 cycles | 104 (81.2) | 82 (78.1) | |
Cisplatin, every 3 wk | |||
1 cycle | 17 (8.9) | 3 (5.7) | 0.447 |
≥ 2 cycles | 174 (91.1) | 50 (94.3) | |
Platinum+5-FU or taxane | |||
1-2 cycles | 15 (40.5) | 5 (35.7) | 0.752 |
≥ 3 cycles | 22 (59.5) | 9 (64.3) | |
Chemotherapy during NCT | |||
1 cycle | - | 5 (2.7) | - |
2 cycles | - | 35 (22.9) | |
≥ 3 cycles | - | 148 (77.1) |
Type of toxicity | CRT (n=150) | NCT (n=150) | p-value |
---|---|---|---|
Acute toxicity (grade 3/4) | |||
Hematologic | |||
Grade 3 | 17 (11.3) | 18 (12.0) | 0.857 |
Grade 4 | 1 (0.7) | 5 (3.3) | 0.214 |
Anorexia/Nausea/Vomiting | 5 (3.3) | 2 (1.3) | 0.448 |
Mucositis/Odynophagia | 27 (18.0) | 29 (19.3) | 0.767 |
Dermatitis | 4 (2.7) | 6 (4.0) | 0.750 |
Xerostomia | 4 (2.7) | 4 (2.7) | > 0.999 |
Any acute toxicity | 57 (38.0) | 59 (39.3) | 0.813 |
Late toxicity (grade 3/4) | |||
Soft tissue fibrosis | 5 (3.3) | 3 (2.0) | 0.723 |
Radionecrosis/Neuropathy | 2 (1.3) | 1 (0.7) | > 0.999 |
Xerostomia | 6 (4.0) | 7 (4.7) | 0.777 |
Ototoxicity | 1 (0.7) | 2 (1.3) | > 0.999 |
Any late toxicity | 14 (9.3) | 13 (8.7) | 0.840 |
Grade 5 toxicity | |||
Radionecrosis/Neuropathy | 0 | 2 (1.3) | 0.498 |
Neutropenia/Infection | 1 (0.7) | 0 | > 0.999 |
Not reported | 2 (1.3) | 2 (1.3) | > 0.999 |
Any grade 5 toxicity | 3 (2.0) | 4 (2.7) | > 0.999 |
Values are presented as number (%) unless otherwise indicated. CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm; SD, standard deviation; ECOG PS, Eastern Cooperative Oncology Group performance status; WHO, World Health Organization; AJCC, American Joint Committee on Cancer; RT, radiation therapy; IMRT, intensity-modulated radiotherapy; F, 5-fluorouracil; P, cisplatin; N/A, not assessed.
HR, hazard ratio; CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm; ECOG PS, Eastern Cooperative Oncology Group performance status; WHO, World Health Organization; RT, radiation therapy; IMRT, intensity-modulated radiotherapy.
CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm; HR, hazard ratio; AJCC, American Joint Committee on Cancer.
Values are presented as number (%) unless otherwise indicated. CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm; PSM, propensity score matching; 5-FU, 5-fluorouracil.
Values are presented as number (%). Treatment toxicities were assessed using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (ver. 3.0). CRT, concurrent chemoradiotherapy arm; NCT, neoadjuvant chemotherapy arm.