May 11, 2011 - Head and neck cancer is the eighth lead- ing cause of cancer mortality worldwide. [20]. In Germany, it accounts for 3.5% of cancer in men and ...
Original article Strahlenther Onkol 2012 · 188:62–70 DOI 10.1007/s00066-011-0009-8 Received: 11 May 2011 Accepted: 15 September 2011 Published online: 23. Dezember 2011 © Springer-Verlag 2011
F. Sadat1 · A. Wienke2 · J. Dunst3 · T. Kuhnt4 1 Clinic of Radiotherapy, Friedrich Alexander University, Erlangen 2 Institute of Medical Epidemiology, Biostatistics and Informatics,
Martin Luther University Halle-Wittenberg, Halle/Saale 3 Clinic of Radiotherapy, University of Schleswig-Holstein Campus Luebeck, Luebeck 4 Department of Radiation Oncology, Clinic of Radiotherapy, University Rostock, Rostock
Survival of patients with head and neck cancer Impact of physical status and comorbidities
Head and neck cancer is the eighth leading cause of cancer mortality worldwide [20]. In Germany, it accounts for 3.5% of cancer in men and 1.5% in women [21]. In 2006, according to the Robert Koch Institute, 10,000 women and 25,000 men were affected with cancer of the oral cavity and pharynx in Germany. The prognosis depends on whether the tumor is detected at an early stage and the application of an extensive treatment is possible [8, 29]. Treatment options of head and neck cancer are manifold. In general, surgery, radiation therapy, and chemotherapy are the mainstays of treating head and neck cancers [14, 16, 25, 26, 27]. The decision for a certain therapy depends on several factors, including the type of cancer, its size and stage, its location, and the patient’s constitution. In patients undergoing definitive radiotherapy, a variety of tumor-based prognostic factors has an impact on outcome, especially tumor volume, stage or the presence of tumor hypoxia [6, 15, 24]. The Karnofsky Performance Index (KPI) and the Eastern Cooperative Oncology Group (ECOG) scales are the most widely used methods of assessing functional status in cancer patients [12, 31]. Both scales are well established and have been shown to correlate well with patient survival [30]. However, comorbid illness(es) and tumor-specific impairments are the most important causes of treatment selection bias because patients
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with relevant comorbidities are at higher risk for complications in case of more aggressive treatment approaches such as radical surgery or multimodal oncological therapy [8]. In addition, patients with comorbidities are often excluded from clinical trials. The selection of younger and healthier patients in clinical trials makes it difficult to expand the results of trials to the general population. Our study focused on the impact of patients’ conditions classified using the KPI/ ECOG in patients with advanced head and neck cancer. Our aim was to evaluate the importance and reliability of KPI/ ECOG and the influence of comorbidity as a contributing factor for the decision on treatment methods and overall survival (OS).
Patients and methods Patients’ characteristics The stage of the tumor was determined on the basis of the diagnostic and histological findings and classified according to the criteria of the TNM classification of the UICC (Union Internationale Contre le Cancer) 1998. All patients underwent a full endoscopic examination and computed tomography (CT) or magnet resonance imaging (MRI) of the site of the primary tumor and the neck. Furthermore, a chest CT, serum chemical analyses, and a complete blood count were obtained. All patients were interviewed using a standardized questionnaire by the attending doctor, including comorbidities, site of tumor, and a query about consumption of alcohol and tobacco.
Tab. 1 Karnofsky Performance Index (KPI) and Eastern Cooperative Oncology Group (ECOG) score KPI score (%)
ECOG score
Definition
100–70
0–1
Able to carry on normal activity and work or limited work activities, but no special care needed
