Release: July 29, 2000
Contact: Kenneth Satterfield
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SURVIVAL RATES FOR YOUNG HEAD AND NECK CANCER PATIENTS DO NOT IMPROVE, DESPITE AVAILABILITY OF AGGRESSIVE TREATMENT
San Francisco, CA: A team of French cancer researchers has determined that younger patients with head and neck squamous cell carcinoma (HNSCC) will have similar outcomes to older patients with the same disease. This occurs despite the consensus that younger patients can tolerate more aggressive treatments for the cancer.
The authors of the study, "Head and Neck Squamous Cell Carcinoma in Young Adults. A Long Term Retrospective Review of 194 Cases, " are J. Sarini MD, Ch. Fournier, J..L. Lefebvre MD, G. Bonafos MD, V. Moncho MD, and A. Kara MD, all from the Centre Oscar Lambret, Northern France Comprehensive Cancer Center, Lille, France. Their findings were presented before the 5th International Conference on Head and Neck Cancer, being held July 29 through August 2, at the San Francisco Marriott, San Francisco, CA. More than 1,500 leading head and neck surgeons from the United States and 46 nations will gather to hear the latest medical research in the diagnosis, treatment, and reconstruction associated with head and neck cancer. The medical conference is sponsored by the American Head and Neck Society, www.headandneckcancer.org.
Methodology: From 1974 to 1983, 4,610 new HNSCC patients were completely evaluated, treated and followed at Centre Oscar Lambret for tumors of the oral cavity, oropharynx hypopharynx or larynx. At- admission age ranged between 18 and 98; 90 percent of the patients were aged of 41 to 74 years. As a result, 40 years and 75 years were selected as the cut-offs to define the patient groups in regard to age. Accordingly, this population is characterized on an arithmetic basis without a particular epidemiological basis.
One hundred and ninety four patients were categorized in the "young patients group", that is to say presenting with a SCC of the oral cavity, larynx, oro-or hypopharynx. The rest of the database was the "control group". Demographics, treatments and outcomes (disease control, causes of death and survival) were compared. Tumors were classified according to the AAJC/UICC recommendations (1997). Clinical staging was assessed at the time of decision making by the multidisciplinary team.
All patients were followed until death or at least 5 years after treatment. In the absence of any precision on the cause of death, all patients with confirmed or suspected disease evolution at last examination prior to death were considered to have passed on as result of the disease. In the absence of any information on the cause of death, patients were not considered as dead of cancer only if they had been examined and considered as free of disease at Centre Oscar Lambret within a period of three months prior to their deaths. All patients dead of intercurrent disease were not considered cancer victims if they had no suspicion of cancer evolution at their last examination and if the nature of the intercurrent disease had been well documented.
The database was divided into two groups. The first group consisted of 194 "young patients" (up to 40 years in age); 4,416 "other patients" (over 40 years in age), 4416 patients. The second grouping consisted of three classifications: 194 "young patients" ( 40 years and younger); 273 "old patients" (75 and over); and 4,143 "middle age patients" (over 40 and under 75 years in age). Percentages were compared using the chi-squared test with optional Yates correction if requested. Survival rates were assessed using the non parametric Kaplan Meier method and log-rang test was used for survival comparisons.
Results: Major findings from the comparison of the two groups found:
-- There was no difference as regards to sex nor to primary site except for larynx cancer that was less frequent in young adults (18.1 vs. 22.7 percent). There was no difference for tumor classification and stage grouping, histological classification or in incidence of simultaneous cancers.
-- Surgery was more frequently performed on those patients under forty and declined as a treatment options patients became 40 and over. The same trend was found for chemotherapy (20.1 percent vs. 17.5 percent vs. 5.5 percent). However, there was no difference in radiotherapeutic treatments or the proportion of persistent diseases, two months after completion of the overall treatment.
-- There was no significant differences in the causes. Similarly, when pooling local, regional and distant failures and metachronous cancers, there was no difference between young adults and older ones. If survival is not meaningful in such a comparison (5-year survival 38.4 percent vs. 33.4 percent), the contrary causes of deaths may be compared. Among the 3,592 patients who were known to be deceased as of the last update, index tumor-related deaths numbered 98 (62.4 percent of deceased in this cohort) in young adults compared to 2160 (62.7 percent of deceased patients in this cohort) which was not significantly different as well as deaths of intercurrent disease (13.3 percent vs. 12.8 percent). On the contrary, there were fewer treatment related-deaths (0.6 percent vs. 2.6 percent).
Conclusion: The researchers believe head and neck carcinoma occurring in patients below 40 years in age is not uncommon. This particular population of head and neck patients does not seem to differ from older patients. Even when their better performance status allows for delivery of more aggressive therapies, their outcome is quite similar to other patients. The study also suggests that attention should be paid to the biological behavior of such tumors in order to understand and overcome their aggressiveness. However the most important action to avoid having to deal with this clinical situation is to intensify campaigns against tobacco smoking with a special targeting on children in order preclude teenage use of tobacco.
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