ETIOLOGICAL, CLINICAL AND PATHOLOGICAL PROGNOSTIC MARKERS IN HEAD AND NECK CANCERS TREATED WITH CONCURRENT CHEMO-RADIATION

Introduction: Advanced squamous cell carcinoma of head and neck are usually treated with surgery and/or radiotherapy. Integration of chemotherapy also plays an important role for improving organ preservation. Various prognostic factors help in selecting the appropriate treatment regimen for the individual patient. The present study was conducted to identify the prognostic factors in head and neck cancers. Material and Methods: Previously untreated 33 patients of squamous cell carcinoma were selected. They were treated with concurrent chemotherapy and radiotherapy. The response assessment was analyzed in terms of various patient, tumor and treatment related factors. Statistical analysis was done using chi square test. Results: Etiological factors- tobacco and alcohol, non-vegetarean diet were associated with a poor outcome but were not statistically significant. Clinical factors- higher N-stage (p=0.04) and AJCC stage (p=0.03) were found to be significant predictors of poor prognosis while T-stage was not found significant, probably due to short follow-up. Patients receiving less than 5 cycles of concurrent chemotherapy had a significantly worse prognosis (p=0.04). Among the pathological factors that were studied, high mitotic index (Grade III or more) were associated with a significantly poorer prognosis (p=0.04). Conclusion: Many clinico pathological factors have been correlated with locoregional control in head and neck cancers. These can be used to individualize the treatment by different surgical techniques, various radiotherapy dose and fractionation schedules and chemotherapy protocols.