PT  - JOURNAL ARTICLE
AU  - Mell, Loren K.
AU  - Shen, Hanjie
AU  - Nguyen-Tan, Phuc Felix
AU  - Rosenthal, David I
AU  - Zakeri, Kaveh
AU  - Vitzthum, Lucas K
AU  - Frank, Steven J
AU  - Schiff, Peter B
AU  - Trotti, Andy
AU  - Bonner, James A
AU  - Jones, Christopher U
AU  - Yom, Sue S.
AU  - Thorstad, Wade L.
AU  - Wong, Stuart
AU  - Shenouda, George
AU  - Ridge, John A.
AU  - Zhang, Qiang E
AU  - Le, Quynh-Thu
TI  - Nomogram to Predict the Benefit of Intensive Treatment for Locoregionally Advanced Head and Neck Cancer
AID  - 10.1158/1078-0432.CCR-19-1832
DP  - 2019 Jan 01
TA  - Clinical Cancer Research
PG  - clincanres.1832.2019
4099  - http://clincancerres.aacrjournals.org/content/early/2019/08/16/1078-0432.CCR-19-1832.short
4100  - http://clincancerres.aacrjournals.org/content/early/2019/08/16/1078-0432.CCR-19-1832.full
AB  - Purpose:Previous studies indicate the benefit of therapy depends on patients' risk for cancer recurrence relative to non-cancer mortality (ω ratio). We sought to test the hypothesis that head and neck cancer (HNC) patients with a higher ω ratio selectively benefit from intensive therapy. Experimental Design:We analyzed 2688 patients with stage III-IVB HNC undergoing primary radiation therapy (RT) with or without systemic therapy on three phase III trials (RTOG 9003, RTOG 0129, and RTOG 0522). We used generalized competing event regression to stratify patients according to ω ratio, and compared the effectiveness of intensive therapy as a function of predicted ω ratio (i.e., ω score). Intensive therapy was defined as treatment on an experimental arm with altered fractionation (AFX) and/or multiagent concurrent systemic therapy. A nomogram was developed to predict patients' ω score based on tumor, demographic, and health factors. Analysis was by intention-to-treat. Results:Decreasing age, improved performance status, higher body mass index, node positive status, P16 negative status, and oral cavity primary predicted a higher ω ratio. Patients with ω score ≥ 0.80 were more likely to benefit from intensive treatment (5-year OS, 70.0% vs. 56.6%; HR 0.73, 95% CI 0.57-0.94; P=0.016) than those with a ω score < 0.80 (5-year OS, 46.7% vs. 45.3%; HR 1.02, 95% CI 0.92-1.14; P=0.69;P=0.019 for interaction). In contrast, the effectiveness of intensive therapy did not depend on risk of progression. Conclusion:HNC patients with a higher ω score selectively benefit from intensive treatment. A nomogram was developed to help select patients for intensive therapy.