CYFRA 21-1 as a Prognostic Marker of Tumor Response to Radiation Alone or Combined With Chemotherapy in Patients With Carcinoma of Larynx or Hypopharynx

J. Mrochem-Kwarciak, T. Rutkowski, K. Składowski, A. Wygoda, R. Deja, A. Hajduk, P. Widłak

Despite of relatively high rate of complete tumor responses after radiotherapy (RT) alone or in combination with chemotherapy (ChRT), locoregional relapse is a major reason of failure for patients with head and neck squamous cell carcinoma (HNC). If treatment failure is diagnosed early, salvage therapy could be possible. Such diagnosis is difficult due to the lack of early prognostic markers for discrimination between residual tumor and treatment-related changes shortly after treatment. The aim of the study was to evaluate clinical value of CYFRA 21-1 as a potential marker of early failure of radiotherapy in patients with laryngeal (LXC) or hypopharyngeal (HPC) cancer. Material and methods: Consecutive 93 patients with LXC (73%) and HPC (27%) were treated between 2009 and 2011 by RT alone (63%), or ChRT (37%). CYFRA 21-1 was estimated before (CYFRA 21-1₁) and at the end (CYFRA 21-1₂) of the treatment. Results: CYFRA 21-1₁ correlated with T and N stages. Median CYFRA 21-1₂ in patients with partial and with complete remission was 2.33 ng/ml, and 1.65 ng/ml, respectively (p=0.0001). Statistically significant differences in 3-year LRC (82% vs. 42%) and OS (57% vs. 40%) were observed between patients groups with CYFRA 21-1₂ <2 ng/ml and ≥ 2 ng/ml, respectively. In multivariate analysis CYFRA 21-1₂ remained significant prognostic factor for LRC (p=0,0003) and OS (p=0.01). Conclusions: CYFRA 21-1 assessed at the end of the RT or ChRT seems to be a prognostic marker for tumor response. Probability of persistent tumor is markedly higher in LXC and HPC patients with CYFRA 21-1 ≥ 2 ng/ml instantly after treatment.