Objectives The effect of smoking and human papilloma virus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemoradiation (CCRT) remains unclear. Study Design Retrospective Review Methods Clinical characteristics of OPSCC patients treated between 2008– 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HR) were examined. Results Out of 120 evaluable patients, 71% had HPV+ tumors. Median follow-up duration for the entire cohort was 41.5 months (6–88 months). HPV+ current smokers experienced significantly worse 5 year OS (73% alive vs. 36% alive, p=0.01) with a similar trend in HPV− current smokers (66% alive vs. 31% alive, p=0.28) compared to former/never smokers undergoing CCRT. In a multivariate cox proportional hazard model adjusted for age, gender, and overall tumor stage, HPV+ current smokers experienced nearly a four-fold increase in overall mortality in comparison to HPV+ never/former smokers (HR= 3.68, 95% CI=1.35–10.0). Similarly, current smokers with HPV− tumors (HR= 6.8, 95% CI=1.11–41.67) had increased mortality compared to never/former smokers. Conclusions Current smoking is associated with poor prognosis, independent of HPV status, in OPSCC CCRT treated patients. Current smoking produced an approximately 4 to 7 fold increase in risk of mortality for HPV+ and HPV− patients respectively. Regardless of pack-years, efforts should be made to achieve smoking cessation before CCRT regardless of HPV status.

Background The objective of the current study was to compare the safety and efficacy between 2 analgesic regimens for patients with head and neck cancer (HNC) undergoing definitive chemoradiation (CRT). Methods The current study was a prospective, single‐institution, 2‐arm, randomized pilot study. Patients with American Joint Committee on Cancer seventh edition stage II to stage IV squamous cell carcinoma of the head and neck who were undergoing CRT were randomized to either arm 1, which entailed high‐dose gabapentin (2700 mg daily) with the institutional standard of care (hydrocodone and/or acetaminophen progressing to fentanyl as needed), or arm 2, which comprised low‐dose gabapentin (900 mg daily) with methadone. The primary endpoints were safety and toxicity. Secondary endpoints were pain, opioid requirement, and quality of life (QOL). Differences between the treatment arms at multiple time points were compared using a generalized linear mixed regression model with Sidak correction. Results A total of 60 patients (31 in arm 1 and 29 in arm 2) were enrolled from April 2015 to August 2017. There was no difference between the treatment arms with regard to adverse events or serious adverse events. Pain was not found to be different between the treatment arms. More patients in arm 1 did not require an opioid during treatment (42% vs 7%; P = .002). Patients in arm 2 experienced significantly better QOL outcomes across multiple domains, including overall health (P = .05), physical functioning (P = .04), role functioning (P = .01), and social functioning (P = .01). Conclusions High‐dose prophylactic gabapentin increased the percentage of patients who required no opioid during treatment. Methadone may improve QOL compared with a regimen of short‐acting opioids and fentanyl. However, pain was found to significantly worsen throughout treatment regardless of treatment arm, necessitating further studies to identify a more optimal regimen.

IMPORTANCE Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are commonly prescribed medications with anti-inflammatory and antiplatelet properties used long term to decrease the risk of cardiovascular events. A recent study showed that aspirin was associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) who were treated with surgery. OBJECTIVE To examine whether use of NSAIDs during definitive chemoradiation therapy (CRT) was associated with improved outcomes in patients with HNSCC.

Background: Limited treatment options are available for oral mucositis, a common, debilitating complication of cancer therapy. We examined the association between daily delivery time of radiotherapy and the severity of oral mucositis in patients with head and neck cancer.Methods: We used electronic medical records of 190 patients with head and neck squamous cell carcinoma who completed radiotherapy, with or without concurrent chemotherapy, at Roswell Park Comprehensive Cancer Center (Buffalo, NY) between 2015 and 2017. Throughout a 7-week treatment course, patient mouth and throat soreness (MTS) was self-reported weekly using a validated oral mucositis questionnaire, with responses 0 (no) to 4 (extreme). Average treatment times from day 1 until the day before each mucositis survey were categorized into seven groups. Multivariable-adjusted marginal average scores (LSmeans) were estimated for the repeated-and maxi-mum-MTS, using a linear-mixed model and generalized-linear model, respectively.Results: Radiation treatment time was significantly associated with oral mucositis severity using both repeated-MTS (n ¼ 1,156; P ¼ 0.02) and maximum-MTS (n ¼ 190; P ¼ 0.04), with consistent patterns. The severity was lowest for patients treated during 8:30 to <9:30 am (LSmeans for maximum-MTS ¼ 2.24; SE ¼ 0.15), increased at later treatment times and peaked at early afternoon (11:30 am to <3:00 pm, LSmeans ¼ 2.66-2.71; SEs ¼ 0.16/0.17), and then decreased substantially after 3 pm.Conclusions: We report a significant association between radiation treatment time and oral mucositis severity in patients with head and neck cancer.Impact: Although additional studies are needed, these data suggest a potential simple treatment time solution to limit severity of oral mucositis during radiotherapy without increasing cost.