JCT  Vol.6 No.5 , May 2015
Competing Causes of Death in 138 Patients with Loco-Regionally Advanced Head and Neck Cancer Treated with Multi-Modality Treatment
Abstract: Introduction: The goal of this study was to analyze the causes of death in patients with loco-regionally advanced squamous cell carcinoma (HNSCC) of the head and neck treated with multimodality treatment. Materiel: The mortality records of 138 advanced head and neck patients treated in our department with surgery and adjuvant (chemo) radiotherapy from 2007 to 2013 were collected and reviewed in this study. Results: From May 2007 to January 2013, 138 patients were followed up with a median follow-up duration of 25 months. The 5-year overall survival (OS), disease-free survival (DFS) were 45%, and 56.1%, respectively. A total of 39 patients (28%) died during the follow-up period. Clearly, in this population, loco-regional relapse accounted for one of the most cause of death but acute and late or chronic treatment-associated causes leading to death occurred in almost 8% of the patients. Furthermore, the risk of death from head and neck squamous cell carcinoma (HNSCC) was greater in patients with hypopharynx cancer. Univariate analysis indicated that patients with N2b disease and above and vascular tumor embolism had a lower overall survival (p = 0.001 and p = 0.007 respectively). The multivariate analysis showed that N2b disease and above was an independent prognostic factor for poorer loco-regional control (p = 0.001). Conclusions: Patients with locally advanced head and neck cancer treated with surgery and adjuvant (chemo) radiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression.
Cite this paper: Dequanter, D. , Shahla, M. , Aubert, C. , Deniz, Y. and Lothaire, P. (2015) Competing Causes of Death in 138 Patients with Loco-Regionally Advanced Head and Neck Cancer Treated with Multi-Modality Treatment. Journal of Cancer Therapy, 6, 423-427. doi: 10.4236/jct.2015.65045.

[1]   Ferlito, A., Haigentz, M., Bradley, P.J., Suarez, C., Strojan, P., Wolf, G.T., Olsen, K.D., Mendenhall, W.M., Mondin, V., Rodrigo, J.P., Boedeker, C.C., Hamoir, M., Hartl, D.M., Hunt, J.L., Devaney, K.O., Thompson, L.D.R., Rinaldo, A. and Takes, R.P. (2014) Causes of Death of Patients with Laryngeal Cancer. European Archives of Oto-Rhino-Laryngology, 271, 425-434.

[2]   Goodwin, W.J. (2000) Salvage Surgery for Patients with Recurrent Squamous Cell Carcinoma of the Upper Aerodigestive Tract: When Do the Ends Justify the Means. Laryngoscope, 93, 1-18.

[3]   Qian, W., Zhu, G., Ji, Q., Guo, Y., Wang, Y. and Wang, Y. (2014) Outcome and Prognostic Factors of 125 Loco-Regionally Advanced Head and Neck Squamous Cell Carcinoma Treated with Multi-Modality Treatment. Zhonghua Zhong Liu Za Zhi, 36, 217-222.

[4]   Schultz, P., Chambres, O., Wiorowski, M., Hemar, P. and Debry, C. (2005) Perioperative Mortality in Oncologic Head And Neck Surgery. Journal of Otolaryngology, 34, 160-165.

[5]   Penel, N., Amela, E.Y., Mallet, Y., Lefebvre, D., Clisant, S., Kara, A., Neu, J.C., Everard, F. and Lefebvre, J.L. (2007) A Simple Predictive Model for Postoperative Mortality after Head and Neck Cancer Surgery with Opening Mucosa. Oral Oncology, 43, 174-180.

[6]   Doll, R., Peto, R., Boreham, J. and Sutherland, I. (2012) Mortality in Relation to Smoking: 50 Years’ Observations on Male British Doctors. British Medical Journal, 328, 1519.

[7]   Carado, S., Moras, F., Pinto, G.J., Bhat, M., Hegde, S., Sattian, B. and Luis, N.A. (2014) Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers. Asian Pacific Journal of Cancer Prevention, 15, 4147-4152.

[8]   Slaughter, D.P., Soutwick, H.W. and Smejkal, W. (1953) Field Cancerization in Oral Stratified Squamous Epithelium; Clinical Implications of Multicentric Origin. Cancer, 6, 963-968.

[9]   Braakhuis, B.J., Tabor, M.P., Kummer, J.A., Leemans, C.R. and Brakenhoof, R.H. (2003) A Genetic Expalanation of Slaughter’s Concept of Field Cancerization: Evidence and Clinical Implications. Cancer Research, 63, 1727-1730.

[10]   De Bree, R., Haigentz, M. and Silver, C.E. (2012) Distant Metastases from Head and Neck Squamous Cell Carcinoma. Part I. Basic aspects. Oral Oncology, 48, 780-786.

[11]   Erkal, H.S., Mendenhall, W.M., Amdur, R.J., Villaret, D.B. and Stringer, S.P. (2001) Synchronous and Metachronous Squamous Cell Carcinomas of the Head and Neck Mucosal Sites. Journal of Clinical Oncology, 19, 1358-1362.

[12]   Coca-Pelaz, A., Rodrigo, J.P. and Suarez, C. (2012) Clinicopathologic Analysis and Predictive Factors for Distant Metastases in Patients with Head and Neck Squamous Cell Carcinomas. Head & Neck, 34, 771-775.

[13]   Milano, M.T., Peterson, C.R., Zhang, H., Singh, D.P. and Chen, Y. (2012) Second Primary Lung Cancer after Head and Neck Squamous Cell Cancer: Population-Based Study of Risk Factors. Head & Neck, 34, 1782-1788.

[14]   Gueret, G., Bourgain, J.L. and Luboinski, B. (2006) Sudden Death after Major Head and Neck Surgery. Current Opinion in Otolaryngology & Head and Neck Surgery, 14, 89-94.

[15]   Gueret, G., Cosset, M.F., McGee, K., Luboinski, F.B. and Bourgain, J.L. (2002) Suddent Death after Neck Dissection for Cancer. Annals of Otology, Rhinology & Laryngology, 111, 115-119.

[16]   Baxi, S.S., Pinheiro, L.C., Patil, S.M., Pfister, D.G., Oeffinger, K.C. and Elkin, E.B. (2014) Causes of Death in Long-Term Survivors of Head and Neck Cancer. Cancer, 120, 1507-1513.

[17]   Argiris, A., Brockstein, B.E., Haraf, D.J., Stenson, K.M., Mittal, B.B., Kies, M.S., Rosen, F.R., Jovanovic, B. and Vokes, E.E. (2004) Competing Cause of Death and Second Primary Tumors in Patients with Loco-Regionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy. Clinical Cancer Research, 10, 1956-1962.