Locoregional and distant recurrence for HPV-associated oropharyngeal cancer using AJCC 8 staging

Contrera, Kevin J.; Smile, Timothy D.; Mahomva, Chengetai; Wei, Wei; Adelstein, David J.; Broughman, James R.; Burkey, Brian B.; Geiger, J.L.; Joshi, Nikhil; Ku, Jamie; Lamarre, Eric; Lorenz, Robert R.; Prendes, Brandon; Scharpf, Joseph; Schwartzman, L.; Woody, N.M.; Xiong, David D.; Koyfman, Shlomo A.

doi:10.1016/j.oraloncology.2020.105030

Cited by 9 publications

(10 citation statements)

References 54 publications

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“…Previous cohorts treated with the NECTORS protocol demonstrated a recurrence rate of approximately 4%, and those who experienced recurrence had high survival rates with salvage therapy . This survival rate is in contrast to patients with OPSCC who were treated with up-front CRT, which historically has had a risk of recurrence of approximately 10% to 15% . Most recurrences in patients with HPV-OPSCC are distant metastatic disease (54 of 81 patients [67%]) and 5-year survival rates in these patients are extremely low, with 98% mortality .…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] This survival rate is in contrast to patients with OPSCC who were treated with up-front CRT, which historically has had a risk of recurrence of approximately 10% to 15%. [35][36][37][38][39] Most recurrences in patients with HPV-OPSCC are distant metastatic disease (54 of 81 patients [67%]) and 5-year survival rates in these patients are extremely low, with 98% mortality. 39 Currently, the patients included in this prospective cohort are in good health, with no evidence of disease; 1 patient is receiving salvage pembrolizumab.…”

Section: Description and Benefits Of Nectorsmentioning

confidence: 99%

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Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Silver,

Bouganim,

Richardson

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceEfforts are underway to deintensified treatment protocols for patients with human papillomavirus virus−associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes.ObjectiveTo assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS.Design, Settings, and ParticipantsThis was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses.Outcome MeasuresQOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes.ResultsAmong the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, −4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, −1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret.Conclusion and RelevanceThe findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Description and Benefits Of Nectorsmentioning

confidence: 99%

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Silver,

Bouganim,

Richardson

et al. 2024

JAMA Otolaryngol Head Neck Surg

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“…Whereas our analysis represents real-world data, patients were not selected for balanced baseline characteristics, and some variables may have been sources of bias. We did not analyze association of prognostic variables with the risk of events, although smoking history and disease stage may be independently associated with the risk of cancer progression for example [24][25][26]. This question should be investigated specifically in HPV-driven and in HPV-negative populations, since their relative weights may well be different.…”

Section: Discussionmentioning

confidence: 99%

Patterns of disease events and causes of death in patients with HPV-positive versus HPV-negative oropharyngeal carcinoma

Gorphe

Classe

Garcia

et al. 2022

Radiotherapy and Oncology

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Background and purpose: There have been no studies to date of patterns of events after oropharyngeal squamous cell carcinoma (OPC) treatment comprising disease progression immediately after treatment or after a disease-free interval (DFI), and causes of death, according to HPV status. Materials and methods: Patients with a T1-4, N0-3, M0 OPC who completed treatment in a curative intent at our center between 2011 and 2020 were analyzed. A DFI was defined as the absence of the disease confirmed by both physical and radiological evaluation. Results: We analyzed 888 patients, of who 451 were p16-positive and 437 were p16-negative. The 5-year survival rates were 82.4% vs. 44%, respectively (p < 0.0001, HR 0.24). The rates of disease progression at the end of the treatment without a DFI were 7.8% vs. 21.1% in the p16-positive vs. the p16-negative patients (p < 0.0001, OR 0.38). The 5-year competing risks of disease recurrence after a DFI were 5.6% vs. 20.5%, respectively (p < 0.0001, HR 0.26). Patients who were p16-positive had a lower risk of death from OPC disease (p < 0.0001, HR 0.23). The 5-year competing risks of a second primary cancer during follow-up were 16.1% vs. 49.9% (p = 0.0002) in the p16-positive vs. the p16-negative patients. Patients who were p16-positive had a lower risk of death from intercurrent causes (p < 0.0001, HR 0.17). Conclusion: Clinical trials and medical interventions dedicated to each category of events and causes of death are needed to improve survival in HPV-positive and HPV-negative OPC patients.

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“…Human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) has a distinct epidemiology, pathophysiology, and response to treatment, and this has led the American Joint Committee on Cancer to create separate staging systems for HPV+ OPSCC 3,4 . Although HPV+ OPSCC is associated with better outcomes than human papillomavirus–negative head and neck squamous cell carcinoma (HPV– HNSCC), 5 approximately 20% of patients with HPV+ OPSCC will experience disease recurrence, most commonly distantly (11%), but locoregional recurrence is also relatively common (9%) 6–9 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 Although HPV+ OPSCC is associated with better outcomes than human papillomavirus-negative head and neck squamous cell carcinoma (HPV-HNSCC), 5 approximately 20% of patients with HPV+ OPSCC will experience disease recurrence, most commonly distantly (11%), but locoregional recurrence is also relatively common (9%). [6][7][8][9] Treatment results are worse for patients with locoregional recurrence than previously untreated patients. In a meta-analysis of results with salvage surgery, Goodwin 10 identified an average overall survival (OS) rate for pharynx cancer of 26% at 5 years; however, the importance of the HPV status was not appreciated at the time of this analysis.…”

Section: Introductionmentioning

confidence: 99%

Surgical salvage of human papillomavirus–positive oropharyngeal cancer: Secondary analysis of a randomized controlled trial

Quan

Grauer

Sunkara

et al. 2022

Cancer

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Background: Survival outcomes are generally better for human papillomavirusassociated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) than other forms of head and neck cancer. However, less is known about oncologic outcomes, late adverse events, and gastrostomy tube dependence associated with salvage surgery after the failure of definitive chemoradiation in patients with HPV+ OPSCC. Methods:A secondary analysis of the Radiation Therapy Oncology Group 1016 randomized trial, which compared radiotherapy plus cetuximab to radiotherapy plus cisplatin in patients with HPV+ OPSCC, was performed. The oncologic and adverse event outcomes for patients who underwent salvage surgery were examined.Results: Among the 805 patients who were assigned to treatment and were eligible for analysis, 198 developed treatment failure. Salvage surgery was required for 61 patients (7.6%), with 33 patients undergoing salvage surgery after locoregional failure (LRF) and 28 patients undergoing salvage neck dissection within the 20 weeks after treatment. Patients with LRF who underwent salvage surgery experienced improved overall survival in comparison with patients with LRF who did not undergo surgery (45% vs. 17% at 5 years after treatment; hazard ratio, 0.41; 95% confidence interval [CI], 0.23-0.74). Surgical salvage after LRF was associated with similar frequencies of late grade 3/4 dysphagia in comparison with LRF without surgery (24% [95% CI, 13%-41%] vs. 20% [95% CI, 12%-32%]; p = .64) and with similar gastrostomy tube dependence at 2 years (29% [95% CI, 15%-49%] vs. 13% [95% CI, 5%-28%]; p = .12).Conclusions: Salvage surgery in patients with HPV+ OPSCC is associated with favorable survival and adverse event outcomes.

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Locoregional and distant recurrence for HPV-associated oropharyngeal cancer using AJCC 8 staging

Cited by 9 publications

References 54 publications

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Patterns of disease events and causes of death in patients with HPV-positive versus HPV-negative oropharyngeal carcinoma

Surgical salvage of human papillomavirus–positive oropharyngeal cancer: Secondary analysis of a randomized controlled trial

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