Role of tumoural markers in the treatment and the prognosis of head and neck cancer

Abstract

Head and neck cancer has important mortality, incidence and prevalence in Romania, therefore prompting for studies meant to detect reliable markers capable of predicting the disease’s progression and its response to treatment. The study was conducted in the Oncology Clinic of Craiova, Romania during ianuarie 2000-decembrie 2009. Patients were randomized 1:1 (using a simple randomization software) in 2 groups: A receiving standard radiotherapy, В comprising patients who received radiochemotherapy (protocol 5-fluorouracil 1000 mg/mp/d iv Cl + Cisplatin 20 mg/mp/d IV Cl x 4 days/4 week or Cisplatin 20 mg/mp IV Cl weekly or 20 mg/mp/d IV 0 x 5 days/3 week). The endpoints of the study were: response rate, median overall survival, disease progression free survival and quality of life in each group. Kaplan Meier curves were used for statistical analysis - for overall survival and the logrank test. The response rate was high for patients with radiochemotherapy which was possible radical surgery. Is significant difference between median overall survival appeared between the 2 groups: 18,8 months in group A and 17,2 months in group В with a hazard ratio for survival of 0,88 (95%CI, 0,75-1,12, p<0.004). Progression free survival was not significant different between these 2 groups: 6.9 months for group A and 7.2 months for group B. Multivariate analysis revealed TNM stage and site of the tumor significant factors for overall survival, and TNM stage, site of the tumor and EGFR expression as significant factors for time to progression. The molecular biomarkers EGFR and VEGF have a prognostic significance in head and neck cancer in addition to the established clinical prognostic factors such as the stage and site of the tumor.Also hypermethylated TSG promoters were detected in saliva using microarray based (DCC, MINT31, pl6, cyclin Al, MINŢI, T1MP3, DAPK) and this test can be a surveillance prediction and model of recurrence that might be applied to screening the population. First line chemoradiotherapy regimen associated with molecular target therapy in advanced head and neck carcinoma remains a decision of the physician. New approaches include the combination of anti VEGFR agents and antiEGFR monoclonal antibodies, and combined antiEGFR therapy with small molecule tyrosine kinase inhibitors.