Head and Neck Cancer

PV 02 - Poster Viewing Q&A - Session 2

MO_21_2852 - A Nomogram for Outcomes after Chemoradiation for Non-HPV-Related Squamous Cell Carcinomas of the Head and Neck - A Pooled Analysis of NRG Oncology RTOG 0129 and 0522

Monday, September 16
10:45 AM - 12:00 PM
Location: ASTRO Innovation Hub

A Nomogram for Outcomes after Chemoradiation for Non-HPV-Related Squamous Cell Carcinomas of the Head and Neck – A Pooled Analysis of NRG Oncology RTOG 0129 and 0522
M. J. Awan1, H. R. Gittleman2, J. Barnholtz-Sloan3, M. Machtay4, P. F. Nguyen-Tan5, D. I. Rosenthal6, V. Takiar7, A. S. Garden6, W. L. Thorstad8, S. Wong1, A. Trotti9, J. A. Bonner10, J. A. Ridge11, G. Shenouda12, M. Suntharalingam13, H. Bahig14, J. Harris15, Q. T. Le16, and M. Yao17; 1Medical College of Wisconsin, Milwaukee, WI, 2Case Comprehensive Cancer Center, Cleveland, OH, 3Case Western Reserve University, Cleveland, OH, 4Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, 5Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada, 6The University of Texas MD Anderson Cancer Center, Houston, TX, 7University of Cincinnati Department of Radiation Oncology, Cincinnati, OH, 8Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO, 9Mofffitt Cancer Center and Research Institute, tampa, FL, 10University of Alabama at Birmingham, Birmingham, AL, 11Fox Chase Cancer Center, Philadelphia, PA, 12McGill University, Montreal, QC, Canada, 13Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 14Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada, 15RTOG, philadelphia, PA, 16Stanford Cancer Institute, Stanford, CA, 17Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH

Purpose/Objective(s): To develop a nomogram for overall survival (OS) for patients receiving chemoradiation for non-HPV related head and neck squamous cell carcinomas (HNSCCs).

Materials/Methods: Patients eligible for this study had hypopharyngeal, laryngeal, or p16-negative oropharyngeal HNSCCs and were enrolled on RTOG 0129 or 0522. De-identified data were extracted from the database as of the most recent publications of these trials (1/3/13 for RTOG 0129 and 6/28/12 for RTOG 0522). Extracted data included age, gender, Zubrod status, baseline hemoglobin, pack-year smoking history, head and neck subsite, clinical T-stage, N-stage, delivered chemotherapy dose, delivered RT fractions, treatment duration, and delivered RT dose. Patients receiving < 60 Gy or with unknown smoking pack-year history were excluded. To consolidate the effect of different RT regimens, time-equivalent biologically effective dose was calculated. The RTOG 0129 dataset was used for nomogram development and the RTOG 0522 dataset was used for nomogram validation. Significant predictors of OS were obtained using univariate analysis on the developmental dataset. The nomogram was built using Cox proportional hazards regression with significant predictors from univariate analysis. This nomogram was internally validated using calibration plots with and without optimism correction and c-statistics on the developmental dataset. This nomogram was then independently validated on the validation dataset using c-statistics. To calculate the bias-corrected 95% confidence interval (CI) for each c-statistic, the c-statistic was bootstrapped using 1,000 resamples for each nomogram for both the developmental and validation datasets. A p ≤ 0.10 was considered significant for all analyses.

Results: 241 patients from RTOG 0129 and 289 patients from RTOG 0522 met the criteria for this analysis. Predictors of worse OS on univariate analysis were older age (p = 0.002), male gender (p = 0.07), Zubrod 1 (p = 0.04), T4 disease (p = 0.001), N2-N3 disease (p < 0.001), hypopharyngeal primary site (p = 0.06), and lower cumulative cisplatin dose (p = 0.003). On multivariable analysis, age (p = 0.02), T4 disease (p = 0.02), N2-N3 disease (p < 0.001), and lower cumulative cisplatin dose remained significant (p = 0.07). The OS nomogram showed excellent correlation both with and without optimism correction. Internal validation of the OS nomogram yielded c=0.67 (95% CI: 0.63-0.72). External validation yielded c=0.65 (95% CI: 0.60-0.70). Nomogram scores successfully stratified patients into low, intermediate and high-risk groups for mortality (p < 0.001).

Conclusion: For non-HPV-related HNSCCs, a nomogram using age, gender, Zubrod, T-stage, N-stage, primary site and chemotherapy dosage was developed and successfully validated for OS outcomes using national clinical trial data.

Author Disclosure: M.J. Awan: None. H.R. Gittleman: None. J. Barnholtz-Sloan: None. M. Machtay: Advisory Board; Stemnion Inc. Consultant; Stemnion Inc, Abbvie. Research Grant; Abbvie. Deputy Chair; NRG Oncology Group, RTOG Foundation. D.I. Rosenthal: Advisory Board; BMS. A.S. Garden: None. W.L. Thorstad: None. S. Wong: Head and Neck Cancer Committee Co-Chair; NRG Oncology. J.A. Bonner: Consultant; Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Serono, Cel-Sci. Honoraria; Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Serono, Cel-Sci. Immediate Past President; The University of Alabama Health Services Found. Professor and Chairman; The University of Alabama at Birmingham. J.A. Ridge: None. H. Bahig: None. Q. Le: Research Grant; Amgen, NIH, Redhill. Travel Expenses; BMS. Chair; Head and Neck Cancer International Group (HNCIG). Head and Neck Committee Chair; RTOG NRG Cooperative group. president elect; American Radium Society. Stock; Aldea. M. Yao: None.

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MO_21_2852 - A Nomogram for Outcomes after Chemoradiation for Non-HPV-Related Squamous Cell Carcinomas of the Head and Neck - A Pooled Analysis of NRG Oncology RTOG 0129 and 0522



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