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Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 58-65

Pattern of failure among HNSCC: An institution-based study

1 Department of Clinical & Radiation Oncology, Delhi State Cancer Institute, Delhi, India
2 Department of Medical Physics & Radiation Oncology, Delhi State Cancer Institute, Delhi, India

Correspondence Address:
Afsana Shah
Department of Clinical & Radiation Oncology, Delhi State Cancer Institute, Delhi 110095
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjoc.bjoc_1_21

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Aim: This retrospective study was conducted to evaluate the pattern of recurrence in head and neck squamous cell carcinoma (HNSCC) patients who received a definitive chemo-radiotherapy. Materials and Methods: In this retrospective study, the data of 308 head and neck patients from January 2015 to March 2015 were analyzed. Only patients who received definitive chemo-radiotherapy were included in the study. The pattern of recurrence was stratified based on age, gender, site involved, histopathological differentiation, stage, habitual risk factors, and treatments received. Results: The mean age of the patients was 51.6 years. No association in the pattern of recurrence based on age, gender, or histopathologic differentiation was found. Patients with habitual risk factors (smoking, tobacco chewing, and alcohol) showed the poorest response to chemo-radiotherapy and unresolved residual disease. Among the primary sites involved, oral cavity patients showed the poorest response with maximum cases of residual disease. In addition, patients with advanced stage remained with residual disease and have a maximum recurrence, and the difference was statistically significant. All the patients who received neoadjuvant chemo-radiation (NACT-RT) as compared to chemo-radiation (CT-RT) had residual disease. According to the pattern of recurrence, the local recurrence was the most common followed by regional and then local and regional, but the distance recurrence was the lowest. Conclusion: Of the patients who have received definitive chemo-radiotherapy, more than half of HNSCC had residual disease. Of the patients with no residual disease, about half of them had recurrence at follow-up. However, no association in the pattern of recurrence was found based on gender or histopathologic differentiation. Patients who have multiple habitual risk factors showed the worst outcome as compared to the patients who have a single habitual risk factor. Patients with multiple habitual risk factors have maximum cases of residual disease and maximum cases of recurrence. Among the habitual risk factors, tobacco chewing was the worst habitual risk factor for refractory residual disease and recurrence. Based on the sites, the patients with carcinoma of the oral cavity showed the worst outcome in terms of residual disease, which is followed by hypopharynx, oropharynx, and then larynx carcinoma, but the rate of recurrence does not depend on the site involved. Advanced-stage patients had a poor response and with maximum cases of recurrence. A combination of chemotherapy with radiation showed better results as compared to the radiation alone in terms of response and recurrence. As to the site of recurrence, the local recurrence was the most common, followed by regional and then distance recurrence. This study indicated that HNSCC is locally aggressive, and local failures are the most common.

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