NODAL CT DENSITY AND TOTAL TUMOR VOLUME AS PROGNOSTIC FACTORS AFTER RADIATION-THERAPY OF STAGE III IV HEAD AND NECK-CANCER/

Purpose: To determine whether the immunohistochemical expression of pr oliferation-associated antigens (proliferating cell nuclear antigen, M IB1) and the nuclear p53 reactivity in addition to total turner volume , nodal CT density and T and N category are predictive for overall sur vival and locoregional tumor control in patients with squamous cell ca rcinoma of the head and neck region. Materials and methods: Between Oc tober 1989 and September 1993, 87 patients with biopsy proven head and neck cancer were randomly allocated to receive radiation alone or sim ultaneous radiation and chemotherapy as part of a multicenter trial wi th a total of 298 randomized patients. There were only inoperable lesi ons in UICC (1992) stage III (8%) and TV (92%). Radiotherapy was deliv ered with 180 cGy twice daily up to a total dose of 7020 cGy in 51 day s. Three cycles of 2340 cGy each were separated by a rest period of 11 days. Chemotherapy consisted of cis-DDP, 5-fluorouracil and leucovori n and was repeated on days 22 and 44. Routinely-processed paraffin-emb edded sections were stained using monoclonal antibodies for detection of proliferation-associated antigens (MIB1 and PCNA) and p53 oncoprote in to determine the labeling index (LI). In addition, the total tumor volume and the percentage of necrosis were measured using CT data. The median follow-up was 3.9 years (range 1.9-5.0 years). Results: The ov erall survival and locoregional control for all 87 patients were 34 an d 39% at 3 years, respectively. The addition of chemotherapy resulted in a better overall survival (27 versus 47%, P = 0.03) but did not inf luence locoregional control (31 versus 47%, P = 0.08). In univariate a nalysis, nodal CT density (P < 0.0001), total tumor volume (P < 0.0001 ), age (P = 0.001) and the MIB1-LI (P = 0.04) had a significant impact on overall survival. However, in the final Cox model only the nodal C T density (P = 0.0003) and age (P = 0.05) were independent prognostic factors for survival and only the nodal CT density (P = 0.0006) was an independent prognostic factor for locoregional control. The expressio n of the p53 oncoprotein was not found to have a clear predictive valu e. Conclusion: Nodal CT density, total tumor volume and age will remai n the relevant prognostic factors in stage III/IV head and neck cancer . (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.