Deintensification of Adjuvant Treatment After Transoral Surgery in Patients With Human Papillomavirus-Positive Oropharyngeal Cancer: The Conception of the PATHOS Study and Its Development

Hargreaves, Sarah; Beasley, Matthew; Hurt, Chris; Jones, Terry M.; Evans, Mererid

doi:10.3389/fonc.2019.00936

Cited by 50 publications

(40 citation statements)

References 65 publications

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“…Currently, there is a drive to examine OPSCC treatment modalities with QoL endpoints (e.g. ORATOR, 22 QoLATI 23 and PATHOS 24 ). The most commonly used QoL questionnaires including the ones used in this study (MDADI, EORTC‐C30, and ‐H&N35) were developed on a patient population predominantly treated with RT or CRT.…”

Section: Discussionmentioning

confidence: 99%

Long‐term quality of life & functional outcomes after treatment of oropharyngeal cancer

et al. 2020

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Functional and QoL outcomes were compared longitudinally in a cohort of patients treated for oropharyngeal squamous cell carcinoma (OPSCC) with primary transoral robotic surgery (TORS) or radiotherapy (RT). Forty‐four patients undergoing primary TORS (n = 31) or RT (n = 13) for any stage OPSCC were included. Only low‐stage disease was treated with TORS. Functional outcomes were: salivary flow rate, image‐based swallowing function, and a self‐reported 10‐point scale comparing current swallowing function to baseline (CvB scale). QoL was assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ‐C30), Head & Neck Module (EORTC QLQ‐HN35), and MD Anderson Dysphagia Inventory (MDADI). Shoulder impairment was assessed with Neck Dissection Impairment Index (NDII) and Oxford Shoulder Score (OSS). In the RT group, salivary flow rates had significantly declined at 12‐month follow‐up, with the biggest declines in QoL subscale scores recorded in the RT group for dry mouth and sticky saliva. Swallowing function on imaging studies was overall good, with no severe dysphagia within 1 year although, both treatment groups showed significant deterioration relative to baseline at the 12‐month follow‐up with increased DIGEST scores and pharyngeal retention. Shoulder impairment was rare at 1 year in both groups. A comprehensive examination of this cohort treated for OPSCC showed overall good functional and QoL outcomes 1 year after treatment. However, persistent impairment was seen in both groups with regards to swallowing function. In the TORS group, at 12‐months follow‐up, the QoL questionnaires showed worse scores in only one subscale (sticky saliva).

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Section: Discussionmentioning

confidence: 99%

Long‐term quality of life & functional outcomes after treatment of oropharyngeal cancer

et al. 2020

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“…These findings may reflect the fact that the VHA population is significantly older 9 and has higher rates of comorbidities compared to the general population 29 . They also highlight the persistent heterogeneity of OPSCC, even as national research efforts are increasingly focused on treatment deintensification and excellent outcomes associated with HPV‐positive OPSCC 27,30‐32 . A more complete, Veteran‐specific analysis of the factors related with OPSCC outcomes (including race and smoking status) is required to provide more informed counseling and prognostication for this population.…”

Section: Discussionmentioning

confidence: 99%

National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System

et al. 2020

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Background: Oropharyngeal squamous cell carcinoma (OPSCC) epidemiology has not been examined previously in the nationwide Veterans Affairs (VA) population. Methods: Joinpoint regression analysis was applied to OPSCC cases identified from VA administrative data from 2000 to 2012. Results: We identified 12 125 OPSCC cases (incidence: 12.2 of 100 000 persons). OPSCC incidence declined between 2000 and 2006 (annual percent change [APC] = −4.27, P < .05), then increased between 2006 and 2012 (APC = 7.02, P < .05). Significant incidence increases occurred among white (APC = 7.19, P < .05) and African American (APC = 4.87, P < .05) Veterans and across all age cohorts. The percentage of never-smokers increased from 8% in 2000 to 15.7% in 2012 (P < .001), and 2-year overall survival improved from 31.2% (95% confidence interval (CI) [30-33.4]) to 55.7% (95% CI [54.4-57.1]). Conclusions: OPSCC incidence is increasing across all racial and age cohorts in the VA population. Smoking rates remain high among Veterans with OPSCC and gains in survival lag those reported in the general population.

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“…Patients with stage T1–T3 N0–N2b HPV+ OPSCC are stratified to pathological subgroups following TORS and LN dissection. Patients in the low-risk group receive no further treatment, patients in the intermediate-risk group are randomized to standard or reduced dose RT, and patients in the high-risk group are randomized to CRT or RT [ 41 , 42 ]. The primary endpoint is noninferiority for OS with coprimary endpoint shallowing function at 12 months.…”

Section: De-escalation Strategiesmentioning

confidence: 99%

De-Escalating Strategies in HPV-Associated Head and Neck Squamous Cell Carcinoma

Economopoulou

Kotsantis

Psyrri

2021

Viruses

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HPV-related head and neck squamous cell carcinoma (HNSCC) has emerged as a diverse clinical and biological disease entity, mainly in young patients with oropharyngeal tumors who are nonsmokers and nondrinkers. Indeed, during the past few years, the pendulum has shifted towards a new epidemiological reality, the “HPV pandemic”, where the majority of oropharyngeal squamous cell carcinomas (OPSCCs) are attributed to HPV. The oncogenic potential of the virus is associated to its capacity of integrating oncogenes E6 and E7 into the host cell, leading to the inactivation of several tumor suppressor genes, such as Rb. HPV status can affect prognosis in OPSCC, but its role as a predictive biomarker remains to be elucidated. Given the favorable prognosis associated with HPV-positive disease, the concept of de-escalation treatment strategies has been developed with the primary intent being the reduction of treatment-related long-term toxicities. In this review, we aim to depict current data regarding treatment de-escalation in HPV-associated OPSCC and discuss ongoing clinical trials.

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Deintensification of Adjuvant Treatment After Transoral Surgery in Patients With Human Papillomavirus-Positive Oropharyngeal Cancer: The Conception of the PATHOS Study and Its Development

Cited by 50 publications

References 65 publications

Long‐term quality of life & functional outcomes after treatment of oropharyngeal cancer

Long‐term quality of life & functional outcomes after treatment of oropharyngeal cancer

National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System

De-Escalating Strategies in HPV-Associated Head and Neck Squamous Cell Carcinoma

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