Human Papilloma Virus-positive Oropharyngeal Squamous Cell Carcinoma in the Elderly

Dave, Eesha; Su, William; Gupta, Vishal; Miles, Brett A.; Demicco, Elizabeth G.; Soriano, Theresa; Bakst, Richard L.

doi:10.21873/anticanres.11520

Cited by 10 publications

(5 citation statements)

References 9 publications

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“…Our institution treats many older adult patients with HNSCC and our experience with unfit, frail patients is consistent with their challenge in receiving treatment [ 47 , 90 , 121 ]. For patients at least 70 years old—either surgical or non-surgical candidates—with HNSCC who cannot or do not want to receive standard RT, a new regimen such as hypofractionation is being investigated at our institution.…”

Section: Ongoing Trials and Future Directionsmentioning

confidence: 87%

Management of Older Adults with Locally Advanced Head and Neck Cancer

Dickstein

Lehrer²,

Hsieh³

et al. 2022

Cancers

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Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity on optimal management. Older adults are a complex patient population, often requiring increased support due to issues relating to functional and performance status, medical comorbidities, and medication management. Furthermore, in older adults with HNSCC, many of these conditions are independently associated with increased toxicity and worse outcomes. Toxicity in the older adult remains difficult to predict and to understand, and as treatment decisions are based on treatment tolerability, it is essential to understand the toxicities and how to minimize them. Novel predictive scores are being developed specifically for older adults with HNSCC to understand toxicity and to assist in personalized treatment decisions. There are clinical trials presently underway that are investigating shortened radiation courses and novel, less toxic systemic treatments in this population. In the forthcoming sections, we provide a detailed overview of the clinical data, treatment paradigms, and considerations in this population. This review provides a comprehensive overview of existing clinical data and clinical considerations in the older adult head and neck cancer population. Additionally, we provide a detailed overview of pertinent current and ongoing clinical trials, as well as future areas for investigation.

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Section: Ongoing Trials and Future Directionsmentioning

confidence: 87%

Management of Older Adults with Locally Advanced Head and Neck Cancer

Dickstein

Lehrer²,

Hsieh³

et al. 2022

Cancers

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show abstract

“…We could not find definite evidence of any difference in patient- or treatment-related factors that affect survival between young and old patient groups. Despite inferior survival in elderly patients, Dave et al [ 12 ] reported a favorable survival outcome for patients older than 65 years with a high tolerability for treatment and insisted that elderly patients should be considered for stage-appropriate care.…”

Section: Discussionmentioning

confidence: 99%

Refining prognostic stratification of human papillomavirus-related oropharyngeal squamous cell carcinoma: different prognosis between T1 and T2

Lee

Park

et al. 2017

Radiat Oncol J

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PurposeTo validate the 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and investigate whether a modified classification better reflects the prognosis.Materials and MethodsMedical records of patients diagnosed with non-metastatic HPV-related OPSCC between 2010 and 2016 at a single institution were retrospectively reviewed. HPV status was determined by immunohistochemical analysis of p16 and/or HPV DNA polymerase chain reaction (PCR). We reclassified TNM stage T0-1 and N0-1 as group A, T2-3 or N2 as B, and T4 or N3 as C. Survival analysis according to 8th AJCC/UICC TNM staging and the modified classification was performed.ResultsOf 383 OPSCC patients, 211 were positive for HPV DNA PCR or p16. After exclusion, 184 patients were included in this analysis. Median age was 56 years (range, 31 to 81 years). Most primary tumors were in the palatine tonsil (148 tumors, 80%). The eighth AJCC/UICC TNM classification could not differentiate between stage I and II (p = 0.470) or II and III (p = 0.209). Applying modified grouping, the 3-year overall survival rate of group A was significantly higher than that of group B and C (98% vs. 91%, p = 0.039 and 98% vs. 78%, p < 0.001, respectively). Differentiation between group B and C was marginally significant (p = 0.053).ConclusionThe 8th AJCC/UICC TNM staging system did not clearly distinguish the prognosis of stage II from that of other stages. Including the T2N0-1 group in stage II may improve prognostic stratification.

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“…Dave et al reported a single institution study of HPV‐OPSCC patients who were ≥65 years and demonstrated excellent 3‐year OS of 85.5%. The superior outcomes in this cohort study was likely due to the younger age of patients and the large number of patients who also underwent surgery (67%) 14 . Finally, Zumsteg et al evaluated survival outcomes in 74 elderly OPSCC patients who underwent CRT and demonstrated excellent LRC of over 88% in patients who received either cisplatin or carboplatin regimens 15 .…”

Section: Discussionmentioning

confidence: 83%

Outcomes of definitive local therapy with intensity‐modulated radiation therapy in elderly patients ≥70 years with HPV‐associated oropharyngeal cancer

Baliga,

Yildiz,

Barve

et al. 2023

Journal of Medical Virology

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The incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing among elderly (≥70 years) patients and the optimal treatment approach is not known. In this study, we aimed to determine disease and toxicity outcomes in an elderly HPV‐OPSCC population primarily treated with a chemoradiation (CRT) approach. We identified 70 elderly HPV‐OPSCC patients who were treated with either surgery, radiotherapy, or CRT between 2011 and 2021. Time‐to‐event analysis for overall survival (OS), progression‐free survival (PFS), and local control (LC) were conducted using the Kaplan–Meier method. Univariate and multivariable cox regression models were used to estimate the hazard ratio associated with covariates. The median follow‐up for our cohort was 43.9 months. Of the 70 elderly patients, 55 (78.6%) receive CRT and 15 (22.4%) received RT alone. Two patients underwent TORS resection. Of the 55 patients treated with CRT, the most common systemic agents were weekly carboplatin/taxol (n = 18), cetuximab (n = 17), and weekly cisplatin (n = 11). The 5‐year OS, PFS, and LC were 57%, 52%, and 91%, respectively. On univariate analysis, Eastern Cooperative Oncology Group performance status and Charlson Comorbidity Index (CCI) were significant predictors of OS, while on multivariate analysis only CCI was a significant predictor of OS (p = 0.006). The rate of late peg tube dependency, osteoradionecrosis, and aspiration was 10%, 4%, and 4%, respectively. Definitive local therapy in elderly HPV‐OPSCC patients is associated with excellent LC and a low rate of late toxicities. Prospective studies are needed to further stratify subgroups of elderly patients who may benefit from aggressive definitive local therapy.

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Human Papilloma Virus-positive Oropharyngeal Squamous Cell Carcinoma in the Elderly

Abstract: Abstract. Background

Cited by 10 publications

References 9 publications

Management of Older Adults with Locally Advanced Head and Neck Cancer

Management of Older Adults with Locally Advanced Head and Neck Cancer

Refining prognostic stratification of human papillomavirus-related oropharyngeal squamous cell carcinoma: different prognosis between T1 and T2

Outcomes of definitive local therapy with intensity‐modulated radiation therapy in elderly patients ≥70 years with HPV‐associated oropharyngeal cancer

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