12. The evaluation of clinical, histological and molecular predictive and grognostic factors in patients with advanced squamous cell cancer of the larynx, meso- and hypopharynx, floor of mouth irradiated after induction chemotherapy

Abstract

Between 1988–1997 198 patients with HNSCC received induction chemotherapy. Clinical staging was as follows ll-7(52%), lll-45(20%), IV-146(64%). Patients received 1 to 4 cycles of Cisplatin + 5FU. Response to chemotherapy (CR or PR) was observed only in patients who received 2–4 cycles of chemotherapy. The best responses were observed in patients with laryngeal, mesopharyngeal and hypopharyngeal cancers, 55%. Radiotherapy was subsequently performed in 178(90%). Twenty patients were not irradiated because of poor performance status or progression of disease after chemotherapy. Radical radiotherapy was performed in 124 (5-year LC 38%, DFS 35%, DSS 43%, OS 30%). All 25 patients irradiated palliatively dyied during 26 months. The best results were observed in patients with laryngeal cancer; LC 48%, DFS 25%, DSS 32%, OS 22%. The most frequent failure was local recurrence in 29(23%) patients. In the next step of this study we want; 1) to assess prognostic and predictive value of selected clinical, histological and molecular factors by defining its influence on the chance of response to chemotherapy and chance of cure 2) to examine the correlation between theses factors and to establish if they give new predictive and prognostic information 3) to establish which of examined factors may be useful in selecting patients with advanced HNSCCs to combined modality treatment (chemotherapy + radiotherapy), and particularily in selecting patients with advanced laryngeal cancer to larynx preservation treatment. We will examine the cell cycle parameter Ki67, expression of p53 protein and expresion of (EGFr). There will be also reevaluated histological material (grading).