Adjuvant Radiation Therapy Alone for HPV Related Oropharyngeal Cancers with High Risk Features

Abstract

BackgroundCurrent standard of care for oropharyngeal cancers with positive surgical margins and/or extracapsular extension is adjuvant chemoradiotherapy. It is unknown whether HPV+ oropharyngeal cancer benefits from this treatment intensification.ObjectiveTo investigate the outcomes of HPV+ patients treated with adjuvant radiotherapy alone when chemoradiotherapy was indicated based on high risk pathological features. They were compared with high risk HPV+ patients treated with adjuvant chemoradiotherapy.MethodsAll high risk HPV+ oropharyngeal cancer patients (9) who received radiotherapy alone were identified. We also identified 17 patients who received chemoradiotherapy as a comparison group. Median follow up time was 37.3 months.ResultsNo local failures developed in adjuvant radiotherapy group. There was 1 distant recurrence in this cohort and 3 in CRT cohort. Regarding toxicity, 8 (47.1%) chemoradiotherapy patients had >10 lb. weight loss (p = 0.013), despite 75% of them having a percutaneous endoscopic gastrostomy tube placed. No individuals in radiotherapy group experienced a >10 lb. weight loss and none required a gastrostomy tube.ConclusionsThis series provides preliminary evidence suggesting that the omission of concurrent chemotherapy to adjuvant radiotherapy may offer comparative local control rates with a lower toxicity profile in the setting of HPV+ patients with traditional high risk features.

Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors

“…The extent of ECS was not graded for this study; however, in a previous publication that included nearly all patients from the current study cohort, application of ECS grading showed the highest grade of ECS (graded STM) to associate with reduced DFS. Administration of adjuvant therapy associated with improved DFS, and reduced number of recurrences correlative with our recently published matched study by Jackson et al However, addition of chemotherapy to postoperative radiation did not associate with additional benefit corroborating findings from the thesis and other reports on HPV‐related OPSCC, some of which include national cancer database analyses . The median (range) adjuvant radiation dose at the primary, ipsilateral, and contralateral neck in our study cohort was 66 (48–70), 66 (36–70), and 56 (45–66) grays (Gy).…”

De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial

“…Although patients treated with chemoradiotherapy alone can be stratified into deintensification groups, pathologic staging information is not obtained, and the potential opportunity to spare them from radiotherapy is lost without that information. In a recent multicenter study, it was reported that 22% of subjects were upstaged and 13% downstaged after surgery indicating the value of pathologic information in this setting [43]. In addition, more recent data indicate that the prognostic impact of the number of cervical lymph nodes appears less important than previously believed [44–46].…”

“…Despite the significant number of reports, the exact role of surgery still remains to be elucidated [50, 51]. Single‐institution data on omission of chemotherapy for patients have indicated that oncologic results are similar, with improved toxicity [43, 50–53]. However, these results must be interpreted cautiously, given the careful patient selection in surgical cohorts.…”

Genomic Characterization of Vulvar (Pre)cancers Identifies Distinct Molecular Subtypes with Prognostic Significance

“…Although our study does not fulfill all criteria for a biomarker study (REMARK criteria; ref. 47), it is the largest (53,54). Of course, this study also has its limitations; our targeted NGS design relies on the parallels between VC and HNC.…”