Original Article
Volume 2024, 10 pages.
Comparison of overall survival rate and disease free survival rate for Chemo-Radiotherapy alone versus Surgery plus Chemo-Radiotherapy for clinically Stage IV head and neck cancer patients
Shrishty Bhardwaj1, Aditya Hurkat2, Ruthvik Soorumsetty
Cleft and Craniofacial Fellow, GS Memorial Hospital, Varanasi
Assistant Professor, Department of Oral and Maxillofacial Surgery Government dental college and Hospital,Jamnagar, Gujarat
Consultant Oral and Maxillofacial Surgeon Hyderabad, India
Address for Correspondence:
Dr. Aditya Hurkat
Assistant Professor, Department of Oral and Maxillofacial Surgery,
Government Dental College and Hospital, Jamnagar, Gujarat
Email – aditya.hurkat@gmail.com
Abstract
Background: Management of clinically Stage IV head and neck squamous cell carcinoma (HNSCC) remains challenging because of advanced local disease, nodal involvement, and the high risk of recurrence. Treatment protocols commonly include surgery followed by adjuvant radiotherapy or chemoradiotherapy, while definitive chemoradiotherapy is preferred in patients unsuitable for surgical management. The present study compared survival outcomes and quality of life between patients treated with definitive chemoradiotherapy and those managed with surgery followed by adjuvant radiotherapy or chemoradiotherapy.
Methods: A retrospective cohort study was carried out in a tertiary care center involving patients diagnosed with clinically Stage IV HNSCC between 2017 and 2019. Patients were allocated into two treatment groups: definitive chemoradiotherapy (CRT alone, n = 34) and surgery followed by radiotherapy or chemoradiotherapy (S+RT/CRT, n = 60). Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan–Meier survival analysis and compared using the log-rank test. Multivariate Cox regression analysis was used to evaluate the influence of potential confounding factors. Quality of life was evaluated using EORTC QLQ-C30 and QLQ-H&N35 questionnaires at baseline and during follow-up.
Results: Patients treated with surgery followed by adjuvant therapy demonstrated superior long-term outcomes. The 5-year overall survival rate was 70% in the S+RT/CRT group compared with 42% in the CRT-alone group. Similarly, disease-free survival was higher in the combined treatment group. Surgical management combined with adjuvant therapy was associated with a lower risk of recurrence and mortality. Patients receiving definitive CRT showed comparatively better short-term quality-of-life scores, particularly in swallowing and speech-related domains during the early post-treatment period. However, long-term quality-of-life outcomes favored the surgically treated cohort, with reduced persistent symptoms and improved social functioning.
Conclusion: Combined modality treatment involving surgery followed by adjuvant radiotherapy or chemoradiotherapy appears to provide better survival outcomes in Stage IV HNSCC when compared with definitive chemoradiotherapy alone. Although surgical treatment may initially affect functional quality-of-life parameters, long-term benefits in disease control and overall well-being support its use in appropriately selected patients.
Keywords: Mandibular segmental resection, Reconstruction plate, Intraoral approach, Extraoral approach, Mandibular reconstruction
Financial support and sponsorship
Nil
Conflicts of interest
There are no conflicts of interest.
How to Cite this article :
Shrishty B., Aditya H., Ruthvik S. Comparison of overall survival rate and disease free survival rate for Chemo-Radiotherapy alone versus Surgery plus Chemo-Radiotherapy for clinically Stage IV head and neck cancer patients. Int J Cranio
Maxillofac Surg Rehab Volume 2024; 3(1): 21-30.
DOI: 10.56501/IntJCranioMaxillofacSurgRehabil.v3.i1.ijcms0059
