Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy

Athanassios Argiris, Bruce E. Brockstein, Daniel J. Haraf, Kerstin M. Stenson, Bharat B. Mittal, Merrill S. Kies, Fred R. Rosen, Borko Jovanovic, Everett E. Vokes

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Purpose: The purpose of this retrospective analysis was to evaluate the emergence of second primary malignancies and the contribution of different causes of death to the outcome of patients with locoregionally advanced head and cancer receiving primary chemoradiotherapy. Experimental Design: We studied 324 patients with stage IV squamous cell head and neck cancer who were enrolled on five consecutive multicenter Phase II studies of concurrent chemoradiotherapy. All of the regimens included concurrent 5-fluorouracil and hydroxyurea on an alternate week schedule with radiotherapy, either alone (FHX) or with cisplatin (C-FHX) or paclitaxel (T-FHX). The cumulative incidence of second primary tumors or death from any cause was estimated using methods of competing risk analysis. Results: Median follow-up of surviving patients was 5. 2 years (2-10.6 years). The 5-year overall survival and progression-free survival of the cohort were 46% and 65%, respectively. Causes of death and median time of occurrence were as follows: disease (n = 88; 1.5 years), treatment-associated acute or late complications (n = 30; 4 months), second primary tumors (n = 18; 3.5 years), comorbidities (n = 41; 1.9 years), and unknown (n = 20; 5.1 years). Predominant causes of death from comorbidities were cardiac and respiratory illnesses. Twenty-six patients (8%) developed a second primary tumor at a median time of 2.8 years (4 months to 10 years). The cumulative incidence of second primary tumors was 5%, 7%, and 13% at 3, 5, and 10 years, respectively. The most frequent site of second primaries was the lung (n = 13), followed by the esophagus (n = 3) and head and neck (n = 2) Conclusions: Patients with locoregionally advanced head and neck cancer treated with concurrent chemoradiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression. Ameliorating toxicity, and implementing secondary screening and chemoprevention strategies are major goals in the management of head and neck cancer.

Original languageEnglish (US)
Pages (from-to)1956-1962
Number of pages7
JournalClinical Cancer Research
Volume10
Issue number6
DOIs
StatePublished - Mar 15 2004
Externally publishedYes

Fingerprint

Chemoradiotherapy
Head and Neck Neoplasms
Cause of Death
Neoplasms
Comorbidity
Squamous Cell Neoplasms
Hydroxyurea
Second Primary Neoplasms
Incidence
Chemoprevention
Paclitaxel
Fluorouracil
Cisplatin
Esophagus
Disease-Free Survival
Disease Progression
Appointments and Schedules
Research Design
Neck
Radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy. / Argiris, Athanassios; Brockstein, Bruce E.; Haraf, Daniel J.; Stenson, Kerstin M.; Mittal, Bharat B.; Kies, Merrill S.; Rosen, Fred R.; Jovanovic, Borko; Vokes, Everett E.

In: Clinical Cancer Research, Vol. 10, No. 6, 15.03.2004, p. 1956-1962.

Research output: Contribution to journalArticle

Argiris, A, Brockstein, BE, Haraf, DJ, Stenson, KM, Mittal, BB, Kies, MS, Rosen, FR, Jovanovic, B & Vokes, EE 2004, 'Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy', Clinical Cancer Research, vol. 10, no. 6, pp. 1956-1962. https://doi.org/10.1158/1078-0432.CCR-03-1077
Argiris, Athanassios ; Brockstein, Bruce E. ; Haraf, Daniel J. ; Stenson, Kerstin M. ; Mittal, Bharat B. ; Kies, Merrill S. ; Rosen, Fred R. ; Jovanovic, Borko ; Vokes, Everett E. / Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy. In: Clinical Cancer Research. 2004 ; Vol. 10, No. 6. pp. 1956-1962.
@article{ac334c8ccc044040b894ba34a828939b,
title = "Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy",
abstract = "Purpose: The purpose of this retrospective analysis was to evaluate the emergence of second primary malignancies and the contribution of different causes of death to the outcome of patients with locoregionally advanced head and cancer receiving primary chemoradiotherapy. Experimental Design: We studied 324 patients with stage IV squamous cell head and neck cancer who were enrolled on five consecutive multicenter Phase II studies of concurrent chemoradiotherapy. All of the regimens included concurrent 5-fluorouracil and hydroxyurea on an alternate week schedule with radiotherapy, either alone (FHX) or with cisplatin (C-FHX) or paclitaxel (T-FHX). The cumulative incidence of second primary tumors or death from any cause was estimated using methods of competing risk analysis. Results: Median follow-up of surviving patients was 5. 2 years (2-10.6 years). The 5-year overall survival and progression-free survival of the cohort were 46{\%} and 65{\%}, respectively. Causes of death and median time of occurrence were as follows: disease (n = 88; 1.5 years), treatment-associated acute or late complications (n = 30; 4 months), second primary tumors (n = 18; 3.5 years), comorbidities (n = 41; 1.9 years), and unknown (n = 20; 5.1 years). Predominant causes of death from comorbidities were cardiac and respiratory illnesses. Twenty-six patients (8{\%}) developed a second primary tumor at a median time of 2.8 years (4 months to 10 years). The cumulative incidence of second primary tumors was 5{\%}, 7{\%}, and 13{\%} at 3, 5, and 10 years, respectively. The most frequent site of second primaries was the lung (n = 13), followed by the esophagus (n = 3) and head and neck (n = 2) Conclusions: Patients with locoregionally advanced head and neck cancer treated with concurrent chemoradiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression. Ameliorating toxicity, and implementing secondary screening and chemoprevention strategies are major goals in the management of head and neck cancer.",
author = "Athanassios Argiris and Brockstein, {Bruce E.} and Haraf, {Daniel J.} and Stenson, {Kerstin M.} and Mittal, {Bharat B.} and Kies, {Merrill S.} and Rosen, {Fred R.} and Borko Jovanovic and Vokes, {Everett E.}",
year = "2004",
month = "3",
day = "15",
doi = "10.1158/1078-0432.CCR-03-1077",
language = "English (US)",
volume = "10",
pages = "1956--1962",
journal = "Clinical Cancer Research",
issn = "1078-0432",
publisher = "American Association for Cancer Research Inc.",
number = "6",

}

TY - JOUR

T1 - Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy

AU - Argiris, Athanassios

AU - Brockstein, Bruce E.

AU - Haraf, Daniel J.

AU - Stenson, Kerstin M.

AU - Mittal, Bharat B.

AU - Kies, Merrill S.

AU - Rosen, Fred R.

AU - Jovanovic, Borko

AU - Vokes, Everett E.

PY - 2004/3/15

Y1 - 2004/3/15

N2 - Purpose: The purpose of this retrospective analysis was to evaluate the emergence of second primary malignancies and the contribution of different causes of death to the outcome of patients with locoregionally advanced head and cancer receiving primary chemoradiotherapy. Experimental Design: We studied 324 patients with stage IV squamous cell head and neck cancer who were enrolled on five consecutive multicenter Phase II studies of concurrent chemoradiotherapy. All of the regimens included concurrent 5-fluorouracil and hydroxyurea on an alternate week schedule with radiotherapy, either alone (FHX) or with cisplatin (C-FHX) or paclitaxel (T-FHX). The cumulative incidence of second primary tumors or death from any cause was estimated using methods of competing risk analysis. Results: Median follow-up of surviving patients was 5. 2 years (2-10.6 years). The 5-year overall survival and progression-free survival of the cohort were 46% and 65%, respectively. Causes of death and median time of occurrence were as follows: disease (n = 88; 1.5 years), treatment-associated acute or late complications (n = 30; 4 months), second primary tumors (n = 18; 3.5 years), comorbidities (n = 41; 1.9 years), and unknown (n = 20; 5.1 years). Predominant causes of death from comorbidities were cardiac and respiratory illnesses. Twenty-six patients (8%) developed a second primary tumor at a median time of 2.8 years (4 months to 10 years). The cumulative incidence of second primary tumors was 5%, 7%, and 13% at 3, 5, and 10 years, respectively. The most frequent site of second primaries was the lung (n = 13), followed by the esophagus (n = 3) and head and neck (n = 2) Conclusions: Patients with locoregionally advanced head and neck cancer treated with concurrent chemoradiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression. Ameliorating toxicity, and implementing secondary screening and chemoprevention strategies are major goals in the management of head and neck cancer.

AB - Purpose: The purpose of this retrospective analysis was to evaluate the emergence of second primary malignancies and the contribution of different causes of death to the outcome of patients with locoregionally advanced head and cancer receiving primary chemoradiotherapy. Experimental Design: We studied 324 patients with stage IV squamous cell head and neck cancer who were enrolled on five consecutive multicenter Phase II studies of concurrent chemoradiotherapy. All of the regimens included concurrent 5-fluorouracil and hydroxyurea on an alternate week schedule with radiotherapy, either alone (FHX) or with cisplatin (C-FHX) or paclitaxel (T-FHX). The cumulative incidence of second primary tumors or death from any cause was estimated using methods of competing risk analysis. Results: Median follow-up of surviving patients was 5. 2 years (2-10.6 years). The 5-year overall survival and progression-free survival of the cohort were 46% and 65%, respectively. Causes of death and median time of occurrence were as follows: disease (n = 88; 1.5 years), treatment-associated acute or late complications (n = 30; 4 months), second primary tumors (n = 18; 3.5 years), comorbidities (n = 41; 1.9 years), and unknown (n = 20; 5.1 years). Predominant causes of death from comorbidities were cardiac and respiratory illnesses. Twenty-six patients (8%) developed a second primary tumor at a median time of 2.8 years (4 months to 10 years). The cumulative incidence of second primary tumors was 5%, 7%, and 13% at 3, 5, and 10 years, respectively. The most frequent site of second primaries was the lung (n = 13), followed by the esophagus (n = 3) and head and neck (n = 2) Conclusions: Patients with locoregionally advanced head and neck cancer treated with concurrent chemoradiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression. Ameliorating toxicity, and implementing secondary screening and chemoprevention strategies are major goals in the management of head and neck cancer.

UR - http://www.scopus.com/inward/record.url?scp=1642382955&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1642382955&partnerID=8YFLogxK

U2 - 10.1158/1078-0432.CCR-03-1077

DO - 10.1158/1078-0432.CCR-03-1077

M3 - Article

C2 - 15041712

AN - SCOPUS:1642382955

VL - 10

SP - 1956

EP - 1962

JO - Clinical Cancer Research

JF - Clinical Cancer Research

SN - 1078-0432

IS - 6

ER -