Prognostic impact of total tumor volume and hemoglobin concentration on the outcome of patients with advanced head and neck cancer after concomitant boost radiochemotherapy

Purpose: To identify prognostic clinical and treatment related factors for local control, distant metastasis-free survival, and survival by means of a multivariate analysis in patients with advanced squamous cell carcinoma of the head and neck after concomitant boost radiochemotherapy. Patients and methods: From 1992 to 1995, 68 patients with squamous cell can cer of the head and neck (93% stage TV disease) were treated with a simulta neous radiochemotherapy with Carboplatin using a concomitant boost techniqu e. The total tumor volume (TTV) was quantitatively determined based on comp uted tomography scans in 56 patients. A Cox proportional hazards regression analysis was performed for each of the above endpoints and statistical sig nificance of the Cox models was verified using the likelihood ratio test an d Bonferroni correction for multiple testing. Results: Thr survival and locoregional control rates at three years were 35 and 32%. The multivariate analysis revealed a significant association betw een the TTV and survival (P = 0.0008) and between the pretreatment serum he moglobin concentration and locoregional control (P = 0.01) and survival (P = 0.05). The locoregional control was significantly associated with the N-s tage (P = 0.007) and there was a good correlation between the N-stage and T TV in this study population. Conclusion: Our data corroborate the prognostic relevance of the tumor volu me and hemoglobin concentration. In studies comparing the survival of patie nts with advanced cancer of the head and neck, the use of the TTV as a cova riable may improve the statistical power. (C) 1999 Elsevier Science ireland Ltd. All rights reserved.