Background: Squamous cell carcinoma of the head and neck (SCCHNC) is the fifth most common cancer in Thailand. Even though the multi-modality treatment including surgery, radiotherapy, and chemotherapy is the standard practice, the survival outcomes are not impressive.

Objective: The primary objectives were to determine the overall survival (OS) and 3-year OS of all patients with SCCHNC and as analysis according to the primary site of the primary tumor. The secondary objectives were progression-free survival (PFS), outcomes of induction chemotherapy (IC), prevalence of serious toxicities from treatments, and independent factors of survival.

Materials and Methods: Retrospective analyses were conducted in patients who had SCCHNC confirmed by histology with complete details of staging and treatment, excluding nasopharyngeal carcinoma, carcinoma of the salivary glands, carcinoma of paranasal sinuses, and cutaneous squamous cell carcinoma.

Results: There were 216 eligible patients. OS of all participants was 24.1 months (IQR 14.3 to 50.1). At the median follow-up of 51.49 months, 3-year OS was 52.2% (95% CI 45 to 95). The patients with primary tumor site at the glottic larynx had the longest OS of 45 months (IQR 21.2 to 64.8). The patients with primary sites at the oral cavity (OS 20.1 months, IQR 13.4 to 45.8), oropharynx (OS 20.05 months, IQR 12.4 to 48.5), hypopharynx (OS 23.3 months, IQR 13.3 to 44.6), and supraglottic or transglottic larynx (OS 25.15, IQR 19.55 to 37.8) had nearly equally worst OS. Stratified by primary site of tumor, the investigators found that PFS of patients with glottic larynx was the longest (23.6 months, IQR 17.5 to 53.4). On the other hand, PFS of patients with supraglottic or transglottic laryngeal cancer, oral cavity cancer, oropharynx, hypopharynx was only 11.35 months (IQR 5.8 to 28.65), 12.5 months (IQR 6.2 to 31.3 months), 13.2 months (IQR 6.3 to 27.8), and 15.1 (IQR 8.9 to 29.3), respectively. The IC did not improve the patients’ outcomes. Thirty patients (22.4%) had serious (grade 3 to 4) adverse effects from definitive treatment, mostly from severe mucositis. The primary sites at the oral cavity and hypopharynx, T4 diseases, and failure to primary definitive treatment were the independent predictors of early deaths.

Conclusion: Due to the very late stage at presentation, the OS of the participants was only two years. The primary sites at the oral cavity and hypopharynx, T4 diseases rather than the composite TNM staging, and failure to primary definitive treatment were the independent prognostic factors of short survival.

Keywords: Squamous cell carcinoma of the head and neck, Multi-modality treatment, Outcomes, Survival

DOI: doi.org/10.35755/jmedassocthai.2020.07.11103

Received 12 Feb 2020 | Revised 7 May 2020 | Accepted 8 May 2020