Late toxicity after radical treatment for locally advanced head and neck cancer Miren Taberna a,b,c,⇑ , Antonio José Rullan a,c , Cinta Hierro d , Valentín Navarro e , Silvia Vázquez a,b , Alicia Lozano f,b , Esther Vilajosana a , Manel Maños g,b,c , Antonio Marí h,b,c , Joan Viñals i,b,c , Ricard Mesía a,b,c a Medical Oncology Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain b Head and Neck Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Spain c Universitat de Barcelona, Spain d Medical Oncology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Spain e Statistics Unit, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain f Radiotherapy Department, Hospital Duran I Reynalds, Catalan Institute of Oncology, Spain g ENT Department, Bellvitge University Hospital, Barcelona, Spain h Maxillofacial Surgery Department, Bellvitge University Hospital, Spain i Plastic and Reconstructive Surgery Department, Head and Neck Unit, Spain article info Article history: Received 25 February 2015 Received in revised form 7 May 2015 Accepted 11 May 2015 Available online 4 June 2015 Keywords: Head and neck cancer Locally advanced head and neck carcinomas Long survivors Late toxicity Quality of life Cisplatin Cetuximab Radiotherapy Quality of life (QoL) summary Background: Multimodal treatment for locally advanced head and neck carcinomas (LAHNC) has been reported to improve survival. However, it is less clear to what extent this survival gain is given at the expense of an impact on the quality of life of our patients. Our aim is to analyze the ongoing late toxic effects among long survivors, to determine how much these impairments affect their QoL, and if there is any factor that clearly impacts on this toxicity. Methods: 152 Patients diagnosed with LAHNC were treated radically in our clinical practice, either with concomitant chemoradiotherapy or bioradiotherapy, with or without induction chemotherapy. We prospectively assessed these patients’ treatment-related late toxicities according to the Radiation Therapy Oncology Group scoring system, and patients answered a QoL question to subjectively evaluate the degree of impact caused by these sequelae in their daily life. Multivariate logistic regressions were performed to detect factors that could influence in toxicity. Results: 21.9% Patients experienced grade 3–4 toxicity. Concomitant chemoradiation with cisplatin was found to be a risk factor of moderate and severe late toxicity compared to concomitant cetuximab in the adjusted analysis by RT fractionation. OR for moderate toxicity 0.292 (CI: 0.125–0.680, p = 0.004); OR for severe toxicity: 0.299 (CI: 0.0909–0.999, p = 0.05). Induction chemotherapy was found to be a pro- tective factor for moderate late toxicity compared to concomitant treatment alone. Conclusion: Patients treated with concomitant chemoradiation with cisplatin have significantly more late toxicity compared to bioradiotherapy, whereas induction chemotherapy prevents from developing mod- erate late toxicity. Ó 2015 Elsevier Ltd. All rights reserved. Introduction Head and neck cancers are a heterogeneous group of cancers that arise from the squamous epithelium in the cavities of the head and neck area. Statistics of patients with squamous cell carcinoma of the head and neck indicate a gradual trend to increased survival of these patients. A recent review about changes in survival in the late 20th and early 21st century demonstrated a major statistically significant improvement in survival among head and neck cancer patients. The overall 5-year relative survival rate went from 54.7% http://dx.doi.org/10.1016/j.oraloncology.2015.05.002 1368-8375/Ó 2015 Elsevier Ltd. All rights reserved. Abbreviations: LAHNC, locally advanced head and neck carcinomas; CRT, chemoradiotherapy; BRT, bioradiotherapy; RT, radiotherapy; RTOG, radiation therapy oncology group; QoL, quality of life question; HPV, Human Papiloma Virus; IMRT, Intensity-Modulated Radiation Therapy; EORTC, European Organization for Research and Treatment of Cancer; CCRT, concomitant chemora- diotherapy treatment; PF, Cisplatin–5Fluorouracil; TPF, Docetaxel–Cisplatin–5Fluo rouracil; PPF, Paclitaxel–Cisplatin–5Fluorouracil. ⇑ Corresponding author at: Department of Medical Oncology, Hospital Duran I Reynalds, Catalan Institute of Oncology, L’Hospitalet de LLobregat, Barcelona, Spain. Tel.: +34 93 260 77 44; fax: +34 93 260 77 41. E-mail address: mtaberna@iconcologia.net (M. Taberna). Oral Oncology 51 (2015) 795–799 Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology