Purpose: The study aimed to analyse causes of death and differential survival after multimodal treatment of head and neck carcinoma patients. Methods and Materials: Between September 2000 and December 2015, 935 patients received a multimodal treatment of head and neck carcinoma. Of these, 562 patients (60.1%) underwent a resection of the primary tumour and a postoperative radio- or radiochemotherapy and 373 patients (39.9%) received definitive radio- or radiochemotherapy. The median follow-up was 21.0 months (0.5 - 175.4 months). Results: At the endpoint of the investigation, 465 patients (49.7%) were alive. The median survival of all patients was 44.8 months (0.5 - 164.3 months). A total of 470 patients (50.3%) died. The causes of death were divided into five groups: 22 patients (2.4%) died of therapy-associated complications with a median of 2.2 months (1.6 - 3.3 months). The 160 patients (17.1%) with intercurrent death, 117 patients (12.5%) with deaths from locoregional progression with or without metastasis, and 86 patients (9.2%) with deaths from metastasis without locoregional recurrence showed comparable survival curves with a median survival of 13.3 months, 13.6 months, and 14.4 months. Eighty-five patients (9.1%) died from second malignant diseases and controlled treated head and neck carcinomas with a median survival of 34.5 months (P < 0.001). Conclusion: Despite a locoregional control and metastasis-free survival of 78.3% patients, only 49.7% of the patients were alive, due to a high rate of intercurrent and second malignant diseases. The short median survival rate is mainly due to the tumours (locoregional and or distant progression) and intercurrent causes of death, with the second malignant diseases leading to death later on.
Multimodal treatment of patients with head and neck carcinoma results in disappointing overall survival rates, despite the substantially better disease-free survival rates in definitive as well as postoperative radiochemotherapy trials. An increased comorbidity of these patients, especially due to smoking and alcohol consumption, is discussed. We analysed our head and neck carcinoma patients multimodally treated with a curative intention from September 2000 to December 2015.
The purpose was to analyse the causes of death and their influence on survival.
Between September 2000 and December 2015, 935 patients (772 male, 163 female) received a multimodal treatment of head and neck carcinoma. The mean age of the patients was 59.3 years (30.5 - 90.2 years). Of these, 562 patients (60.1%) underwent a resection of the primary tumour and a postoperative radio- or radiochemotherapy and 373 patients (39.9%) received definitive radio- or radiochemotherapy only. After treatment, all patients underwent frequent follow-up examinations with an otolaryngologist and a radiooncologist. The median follow-up was 21.0 months (0.5 - 175.4 months), and the loss to follow-up was 13.3% (124 patients). Patients’ characteristics are shown in
Survival rates were estimated according to the Kaplan-Meier method; differences between groups were assumed by means of the log-rank statistic. For statistical analysis, Microsoft Excel 2008 and SPSS Version 23 were used.
At the endpoint of the investigation, 465 patients (49.7%) were alive. The median survival of all patients was 44.8 months (0.5 - 164.3 months). During the investigated interval, 470 patients (50.3%) died. Female patients showed a median survival of 80.3 months whereas male patients had a median survival of 40.3 months (P < 0.001) (
| Gender | ||
|---|---|---|
| Male | 772 | 82.6% |
| Female | 163 | 17.4% |
| Primary Tumour Localisations | ||
| Oropharynx | 340 | 36.4% |
| Larynx | 140 | 15.0% |
| Hypopharynx | 131 | 14.0% |
| Floor of the mouth | 120 | 12.8% |
| Tongue | 53 | 5.7% |
| CuP | 48 | 5.1% |
| Nasopharynx | 39 | 4.2% |
| Paranasal sinuses | 25 | 2.7% |
| Salivary glands | 19 | 2.0% |
| Skin | 11 | 1.2% |
| Ear canal | 5 | 0.5% |
| Lip | 4 | 0.4% |
| UICC Stage | ||
| I | 31 | 3.3% |
| II | 72 | 7.7% |
| III | 129 | 13.8% |
| IVA | 656 | 70.2% |
| IVB | 46 | 4.9% |
| IVC | 1 | 0.1% |
| Primary Tumour Resection | ||
| Without resection | 373 | 39.9% |
| R0 | 381 | 40.7% |
| R1 | 181 | 19.4% |
The causes of death were divided into five groups: therapeutic-associated deaths, intercurrent deaths with locoregional and systemic tumour control, deaths due to and after a locoregional recurrence, deaths with distant metastasis and a locoregional controlled tumour, and deaths from a second malignant disease. Twenty-two patients (2.4%) died from therapy-associated complications after a median of 2.2 months (1.6 - 3.3 months) and had a significant lower median survival (
The 160 patients (17.1%) with intercurrent deaths, 117 patients (12.5%) with deaths from locoregional progression with or without metastasis, and 86 patients (9.2%) with deaths from metastasis without locoregional recurrence showed comparable survival curves with a median survival of 13.3 months, 13.6 months,
and 14.4 months, respectively. Eighty-five patients (9.1%) died from a second malignancy and controlled head and neck carcinoma. They had a significantly longer median survival of 34.5 months (P < 0.001). Fifty-one of the 85 (60%) fatal second malignant diseases were lung cancer diseases, 10 patients (12%)
| n | (%) | Median Survival | |
|---|---|---|---|
| All patients | 935 | 100 | 16.0 months |
| Deceased patients | |||
| Therapy associated | 22 | 4.7 | 2.4 months |
| Intercurrent disease | 160 | 34.0 | 13.2 months |
| Locoregional progression ± metastasis | 117 | 24.9 | 13.6 months |
| Metastasis and locoregional control | 86 | 18.3 | 14.6 months |
| Second malignant disease | 85 | 18.1 | 34.5 months |
suffered from oesophageal carcinoma, and 5 patients (6%) from a second head and neck carcinoma.
For patients receiving postoperative radio- or radiochemotherapy, locoregional control rates after 2 years were between 46% and 82% [
The published survival rates of postoperative treated patients were 56% - 71% after 2 years [
Bernier et al. described a rate of second malignant diseases after 5 years of 12.5% [
In comparison to the published trials, we treated an unselected patient population. The median age of our patient group is an average of 5 years older. We treated a larger spectrum of primary tumour localisations, and 381 of 935 (41.7%) patients had exclusion criteria of the mentioned radiochemotherapy trials.
One reason for the short survival of these patients could be high comorbidity due to long-term alcohol and nicotine consumption, when 34% of the patients died from intercurrent diseases. These patients did not live longer than patients who died due to the failure of locoregional therapy or exclusively distant disease progression. Patients who survived longer had a high risk of suffering from a second malignant disease with a reduced prognosis.
The survival of patients with head and neck carcinoma after definitive or postoperative radio-chemotherapy was lower despite acceptable locoregional control rates of treatment.
All authors declare no conflicts of interest.
Buchali, A., Huhnt, W., Maekelburg, I., Rohrberg, S., Sidow, D., Blank, E., Schroeder, C. and Franzen, A. (2017) The Survival of Head and Neck Carcinoma Patients Depends on Secondary Causes of Death. Journal of Cancer Therapy, 8, 1187-1193. https://doi.org/10.4236/jct.2017.813102