Chemoradiation for metastatic SCCA: Role of comorbidity

Objectives. A previous study of 371 patients with extracapsular spread (ECS ) of cervical metastases from squamous cell carcinoma (SCCA) of the head an d neck revealed a survival advantage for patients treated with adjuvant che moradiation, compared with those treated with surgery and radiation or surg ery alone. While all patients in the study were offered adjuvant chemothera py, only 35% selected this option. Comorbidity was identified as a reason f or declining chemotherapy. Recently, Piccirillo demonstrated that the Modif ied Medical Comorbidity Index (MMCI) is a valid instrument to classify and quantify severity of comorbidity. We applied this instrument to previously reported patients with ECS to determine 1) how comorbidity affected treatme nt selection, 2) whether the survival advantage of adjuvant chemoradiation persisted after controlling for comorbidity, and 3) the impact of comorbidi ty on outcome. Study Design: This was a nonrandomized, retrospective study. Methods: Patients in the initial study underwent resection of the primary tumor and neck dissection. Eligible patients elected to receive chemoradiat ion, radiation, or no further treatment. Comorbidity scores were assigned a ccording to the MMCI. Data were analyzed according to disease-specific surv ival and overall survival. Results: The study population consisted of 330 p atients. More severe comorbidity was related to higher overall mortality ra tes after controlling for treatment. Adjuvant chemoradiation resulted in im proved disease-specific and overall survival compared with adjuvant radiati on after adjusting for severity of comorbidity. Conclusions: These results substantiate the benefits of adjuvant chemoradiation for patients with SCCA of the head and neck. Furthermore, these results reinforce the importance of comorbidity as a prognostic indicator for this population of patients.