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Background Overexpression of p16 is associated with improved outcomes among patients with oropharyngeal carcinoma. However, its role in nasopharyngeal cancer patient outcomes remains unclear. Methods Eighty-six patients with nasopharyngeal carcinoma treated at MD Anderson from 2000 to 2014 were identified. Epstein bar virus (EBV) and Human papillomavirus (HPV) status were determined by in situ hybridization and p16 by immunohistochemical staining. Results EBV positivity was associated with extended overall survival (median 95.0 vs. 44.9 months, P<0.004), progression-free survival (PFS) (median 80.4 vs. 28.1 months, P<0.013) and locoregional control (LRC) (median 104.4 vs. 65.5 months, P<0.043). In patients with EBV-positive tumors, p16 overexpression correlated with improved PFS (median 106.3 vs. 27.1 months, P<0.02) and LRC (median 93.6 vs. 64.5 months, P<0.02). Conclusion P16 overexpression is associated with improved PFS and LRC in patients with EBV-positive nasopharyngeal carcinoma. p16 expression may complement EBV status in predicting treatment outcomes for nasopharyngeal carcinoma patients.

Background Treatment of T4 nasopharyngeal carcinoma (NPC) is challenging because of the proximity of the tumor to the central nervous system. The purpose of this study was to present our evaluation of disease control and toxicity outcomes for patients with T4 NPC treated with intensity‐modulated radiation therapy (IMRT) and chemotherapy. Methods The medical records of 66 patients with T4 NPC treated from 2002 to 2012 with IMRT were reviewed. Endpoints included tumor control and toxicity outcomes (Common Terminology Criteria for Adverse Events [CTCAE v4.0]). Results Median follow‐up was 38 months. Five‐year rates of locoregional control, distant metastasis‐free survival, progression‐free survival (PFS), and overall survival (OS) were 80%, 62%, 57%, and 69%, respectively. Nodal involvement was associated with worse PFS (p = .015). Gross target volume (GTV) volume >100 cm and planning target volume (PTV) volume >400 cm were associated with worse OS (p = .038 and p = .004, respectively). Four patients had significant cognitive impairment, and 9 had MRI evidence of brain necrosis. Conclusion For patients with T4 NPC treated with IMRT and chemotherapy, survival and locoregional disease control rates have improved; however, late treatment toxicity remains a concern. © 2015 Wiley Periodicals, Inc. Head Neck 38: E925–E933, 2016

Favorable disease control rates for orbital carcinomas are achievable with IMRT after orbital exenteration even for patients with advanced disease. Toxicity for the contralateral eye was minimal. © 2015 Wiley Periodicals, Inc. Head Neck 38: E580-E587, 2016.