Sažetak
Background: Head and neck tumours are diverse, heterogeneous, and are relatively difficult to diagnose/stage. The use of chemoradiation for these cancers has been associated with better outcomes but has not been fully studied in this environment. Thus, this study aims at describing the pattern of presentation and mode of management of patients with head and neck cancers while exploring the impact of chemoradiation on treatment outcomes and survival in these patients.
Methods: Using a retrospective study design, clinical data was obtained for 406 patients who were treated for head and neck cancers between January 2001 and December 2011.
Results: The mean age was 49±17.1 years with a 2:1 male to female ratio. More tumours were located in the nasopharynx (18.0%) than anywhere else, and the bulk of patients presented with stage 4 diseases (48.5%). Most patients (37.5%) presented with a neck mass, then nasal blockage (23.4%). Squamous cell carcinoma was more prevalent (57.4%) and 73.6% had biopsy before and during surgery, while 26.4% had definitive surgical procedures done. Radiotherapy was the sole treatment in 41.4% and 29.1% had chemoradiation. Post-treatment, 63.1% experienced complete response; 28.3% partial response, and 14% recurrence. Most patients (39.8%) survived for six months post-treatment, 30.7% for 7-12 months, and 17.5% for 13-24 months and patients who received chemoradiation had longer survival.
Conclusion: Early presentation for diagnosis and treatment will definitely improve treatment outcome and survival duration. In addition, concurrent use of chemoradiation improves the treatment outcomes.
Keywords: Chemoradiation, cancer, Nigeria, head and neck, radiotherapy
Résumé
Contexte: Les tumeurs de la tête et du cou sont diverses, hétérogènes et relativement difficiles à diagnostiquer / classer. L’utilisation de la chimioradiothérapie pour ces cancers a été associée à de
meilleurs résultats, mais n’a pas été entièrement étudiée dans cet environnement. Cette étude vise donc à décrire le schéma de présentation et le mode de gestion des patients atteints de cancers de la tête et du cou, tout en explorant l’impact de la chimioradiothérapie sur les résultats du traitement et la survie de ces patients.
Méthodes: En utilisant une structure d’étude rétrospective, les données cliniques ont été obtenues pour 406 patients traités pour un cancer de la tête et du cou entre janvier 2001 et décembre 2011.
Résultats: L’âge moyen était de 49 ± 17,1 ans avec un ratio hommes / femmes de 2:1. Plus de tumeurs étaient localisées dans le nasopharynx (18,0%) que partout ailleurs et la majorité des patients présentaient des maladies de l’étape 4 (48,5%). La plupart des patients (37,5%) ont présenté une masse au cou, puis un blocage nasal (23,4%). Le carcinome épidermoïde était plus prévalent (57,4%) et 73,6% avaient subi une biopsie avant et pendant la chirurgie, tandis que 26,4% avaient subi une intervention chirurgicale définitive. La radiothérapie était le seul traitement chez 41,4% des patients et 29,1% avaient une chimioradiothérapie . Après le traitement, 63,1% ont eu une réponse complète; 28,3% de réponse partielle et 14% de récurrence. La plupart des patients (39,8%) ont survécu six mois après le traitement, 30,7% de 7 à 12 mois et 17,5% de 13 à 24 mois, et les patients ayant reçu une chimioradiothérapie ont eu une survie plus longue.
Conclusion: Une présentation précoce pour le diagnostic et le traitement améliorera définitivement le résultat du traitement et la durée de survie. En outre, l’utilisation simultanée de la chimioradiothérapie améliore les résultats du traitement.
Mots-clés: Chimioradiothérapie, cancer, Nigéria, tête et cou, radiothérapie
Correspondence: Dr. Omolara A. Fatiregun, Oncology Unit, Department of Radiology, Lagos State University Teaching Hospital, Ikeja. Lagos, Nigeria, Email: omolarafatiregun@gmail.com
Reference
Seiwert TY, Salama JK and Vokes EE. The Chemoradiation paradigm in head and neck cancer. Nat. Clin Pract Oncol. 2007,4(3)156-171.
Conley BA, Forastiere AA, Gius D and vanWales C. Head and neck cancer. In: Abraham J, Allegra CJ and Gulley J (Eds). Bethesda hand book of clinical oncology 2nd ed. 2005. Lippincott Williams and Wilkins.
Nwawolo CC, Ajekigbe AT, Oyeneyin JO, Nwankwo KC and Okeowo PA. Pattern of head and neck cancers among Nigerians in Lagos. West Afr J Med 2001; 20:111-116.
Nwaorgu O, Kokong D, Onakoya P, Adoga S and Ibekwe T. Prevalence of human immunodeficiency virus seropositivity in head and neck malignancies in sub-Saharan Africa. Acta Oto-Laryngol 2007; 127:1218-1221.
Ahmad BM and Pindiga UH. Malignant neoplasms of the ear, nose and throat in north eastern Nigeria. Highland Med Research J 2004, 2:45-48.
Iseh KR and Malami SA. Pattern of head and Neck cancers in Sokoto- Nigeria. Nig J Otolaryngol 2006; 3:77-83.
Ologe FE, Adeniji KA and Segun-Busari S. Clinicopathological study of head and neck cancers in Ilorin, Nigeria. Tropical doctor 2005; 35:2-4.
Okoye BCC and Nwosu SO. Primary head and neck malignant tumours in Port Harcourt, Nigeria. Orient J Med 1995; 7:38-40.
Adeyemi BF, Adekunle LV, Kolude BM, Akang EE and Lawoyin JO. Head and neck cancer- a clinicopathological study in a tertiary care centre. J Natl Med Assoc 2008; 100:690-697.
Onyango JF, Awange DO, Njiru A and Macharia IM. Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital Nairobi. East Afr Med J 2006; 83:288-91.
Silverberg E, Boring C, Squires TS: Cancer statistics. 1990, 40:9-9.
Onyango JF and Macharia I. Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi. East Afr Med J. 2006; 83:85-91.
Sasaki CT and Carlson RD: Malignant neoplasms of the larynx. In: Otolaryngology head and neck surgery. 2nd edition. Edited by Cummings CW. St. Louis Mosby Year Book; 1993:1925-1954.
Vokes EE and Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. New Engl J Med 1993; 328:184-194.
Elmes GGT and Baldwin RGT. Malignant disease in Nigeria: An analysis of a thousand tumours. Ann Trop Med Parasit 1947; 41:321-328.
Sowemimo GOA, Ademiluyi SA and Oyeneyin JO. Salivary gland tumours. Nig Med J 1978; 8:119-123.
Edington GM and Gilles HM. Pathology in the Tropics. London, Edward Arnold; 1969:466-467.
Martinson FD. Cancer of the Nasopharynx in Nigeria. J Laryngol 1968; 82:1119-1126.
Otoh EC, Johnson NW and Danfillo IS; Primary head and neck cancers in North Eastern Nigeria. West Afr J Med 2004; 23:305-313.
Somefun AO, Nwawolo CC, Okeowo PA and Alabi SB: Prognostic factors in the management outcome of carcinoma of the larynx in Lagos. Niger Postgrad Med J 2003; 10:103-106
Martinson FD. Nasopharygeal cancer in Nigeria. ARC Scientific publication No 63 OAU/STRC. Scientific publication No. 1 Lyon International Agency for Research on cancer; 1984:501-511.
Ketiku KK, Igbinoba F and Okeowo PA. Nasopharyngeal cancer in Nigeria – A revisit. Niger Postgrad Med J 1998; 5:7-11.
Lilly-Tariah da OB and Somefun AO. Malignant tumours of the Nasopharynx at Jos University Teaching Hospital, Nigeria. Niger Postgrad Med J 2003; 10:99-102.
Okafor BC. Otolaryngology in South- Eastern Nigeria III. Pattern of diseases of the throat. Nig Med J 1983; 13:30-41.
da Lilly-Tariah OB, Ukoli CO and Nwana EJC. Cancer of the larynx in black Africans in Jos, Nigeria. Cent Afr J Med. 1999; 45(2):40-42.
DeVita VT, Hellman S and Rosenberg SA, eds. Cancer: principles and practice of oncology, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2001:797.
Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin 2003; 53:5-26
Chen J, Katz RV and Krutchkoff DJ. Intraoral squamous cell carcinoma. Epidemiologic pattern in Connecticut for 1935 to 1985. Cancer 1990; 66:1288-1296.
Rouviere H. Anatomy of the human lymphatic system. Ann Arbor, MI: Edwards Brothers, 1938, Tobias MJ, translator.
Bhatia PL. Head and neck cancer in Plateau State of Nigeria. West Afr J Med 1990; 9:304-310.
da Lilly-Tariah OB, Nwana EJC and Okeowo PA. Cancers of the ear, nose and throat. Nig J Surg Science 2000; 10:52-56.
Mendenhall WM, Mancuso AA and Parsons JT. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998; 20:739
Mendenhall WM, Mancuso AA and Amdur RJ. Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site. Am J Otolaryngol 2001; 22:261.
Browman GP, Charette M and Oliver T. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis. Head Neck 2001; 23: 579–589
Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350: 1937–1944
Bachaud JM, Cohen-Jonathan E and Alzieu C. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996; 36: 999–1004
Munro AJ. Chemotherapy for head and neck cancer. In: Souhami RL, Tannock I, Hohenberger P, eds. Oxford textbook of oncology, 2nd ed. New York: Oxford University Press Inc., 2002, 1345