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Background Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods Retrospective analysis of 58 patients with head and neck CUP treated with intensity‐modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx‐sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion In this single institution study, a 56 Gy IMRT‐based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx‐sparing IMRT.

45 years of age. Relevant demographic, tumor, and survival variables were extracted for analysis. Hospitals were divided into community cancer programs (100-500 annual cancer cases) and comprehensive community or academic/research programs (500 annual cancer cases). Cox regression was used to identify predictors of survival. Results: We identified 54,565 OCSCC patients, 7.6% of whom are younger than 45 years of age (nZ3828). Of these patients, 80% were between 35 and 44 years of age. More males were affected (65.7%) than females. Caucasians represented 86.3% of cases, followed by African Americans (9.5%) and patients of "other" races (4.2%). Private insurance (65.6%) was most common, with Medicaid (17.6%), uninsured (11.7%), and Medicare (5.1%) comprising the rest. Overall survival at 2 and 5 years was 76% and 66%, respectively. The oral tongue subsite was most common (55.4%), followed by floor of mouth (FOM; 28.5%), gingiva/retromolar trigone (15.4%), and buccal mucosa (0.7%). An increasing incidence of oral tongue cancers was seen, while FOM cancers showed a decreasing trend over the study period. A minority of cases was treated at low-volume community cancer centers, which saw more stage I-II disease. Uninsured and Medicaid patients had more advanced stage III-IV disease (P<.001), while those with private insurance had more early-stage disease. Further analysis including treatment, insurance, demographics, and survival was performed. cStage I-II patients without private insurance were more likely to receive some form of chemotherapy. Ethnicity, insurance status, income, age group, pathologic stage, and positive surgical margins are significant prognosticators on univariate analysis. In multivariate analysis, high pathologic stage, nonprivate insurance, treatment at a low-volume community center, and positive margins remained predictors of worse survival. Conclusion: In young patients with oral cavity cancers, differences in treatment, presentation, and survival were seen in those with health disparities. In addition to staging and surgical margins, treatment at low-volume community cancer centers and nonprivate insurance status predicted worse survival.

Purpose/Objective(s): Concurrent carboplatin and taxol (C/T) is commonly utilized in the management of head and neck squamous cell carcinoma (HNSCC) based on phase 2 data. At our institution we underwent a shift in practice over a relatively short period of time from frequent use of concurrent C/T to predominantly cisplatin (Cis)-based concurrent therapy. We sought to determine cancer-specific outcomes with Cis-based versus C/T concurrent therapy. Materials/Methods: We retrospectively analyzed 336 consecutive patients (pts) with oropharyngeal HNSCC treated at a single institution with definitive intensity modulated radiation therapy to a median dose of 70 Gy (median 2 Gy/fraction) using predominantly a dose-painting technique. Univariable and multivariable Cox proportional hazard regression models were used to evaluate the association of concurrent chemotherapy-type with overall survival (OS), recurrence-free survival (RFS), local-recurrence failure (LRF), and distant metastasis (DM). The multivariable model included clinical predictors that were significant in the univariate model for survival outcomes with a P value .05. The Fine & Gray method was used to adjust for competing risks. Results: The cohort comprised 336 pts, mostly male (85%), with a median age of 57.3 years. The most common sites were tonsil (49.4%) and base of tongue (46.7%). The American Joint Committee on Cancer stage was I (0.3%), II (3.9%), III (1.1%), IVA (71.5%), and IVB (9.2%). Most pts were human papillomavirus (HPV)-positive (72.3%), 13.1% were HPV-negative, and 14.6% had unknown HPV status. Pts received upfront concurrent chemoradiation (58%) or sequential therapy (38.4%); 3.6% received radiation and no chemotherapy. Eighty pts (23.8%) received Cis-based concurrent chemotherapy, and 103 pts (30.7%) received weekly C/T concurrent chemotherapy. With a median follow-up of 3.8 years, the 3-year OS was 89.3% with CI of LRF of 9.6% and CI of DM of 9.1%. Compared with Cis-based concurrent chemotherapy, pts that received weekly C/T had worse OS (hazard ratio [HR] 6.57; 95% confidence interval [CI] 1.54-28.0) and RFS (HR 3.38; 95% CI 1.29-8.87) and higher rates of LRF (HR 9.42; 95% CI 1.26-70.5). The significantly worse OS seen with C/T concurrent chemotherapy remained statistically significant after adjusting for stage, HPV status, and initial comorbidities (HR 5.00; 95% CI 1.15-21.79) and after restricting the analysis to the 207 pts that received concurrent chemotherapy without induction (HR 8.88; 95% CI 1.56-68.23). Conclusion: Concurrent carboplatin and taxol was associated with worse OS and cancer-specific outcomes following definitive radiation-based therapy for SCC of the oropharynx. Cisplatin-based therapy should continue to be the concurrent therapy of choice for oropharyngeal SCC.

study demonstrates that AA patients classified as intermediate risk may have outcomes more similar to high risk patients and thus race may be an important part of future staging systems.