Primary surgery versus primary radiation‐based treatment for locally advanced oropharyngeal cancer

Kamran, Sophia C.; Qureshi, Muhammad M.; Jalisi, Scharukh; Salama, Andrew; Grillone, Gregory A.; Truong, M.T.

doi:10.1002/lary.26903

Cited by 31 publications

(25 citation statements)

References 33 publications

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“…Several studies have demonstrated a better quality of life (QOL) in patients who underwent primary surgery for OPSCC . Recent single and dual‐institutional studies show that primary surgical treatment has a comparable OS to primary chemoradiation . Up‐front surgery also has an additional advantage of histopathologic staging …”

Section: Introductionmentioning

confidence: 99%

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

et al. 2019

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Objective Survival outcomes for human papillomavirus‐associated oropharynx squamous cell carcinoma (HPV + OPSCC) treated with surgery alone are unclear. To increase understanding, we assessed overall survival (OS) outcomes using the national cancer database (NCDB). Methods We conducted a retrospective analysis of OS of 736 NCDB HPV + OPSCC patients who underwent surgery alone from 2010 to 2014 using univariate and multivariate analyses and the Kaplan‐Meir method. Results Multivariable analysis found the following independent risk factors for death: American Joint Commission on Cancer (AJCC) 8th edition pathologic stage(p)N2 versus pN0 disease (hazard ratio [HR], 5.5; P = 0.000006), macroscopic extranodal extension (ENE) versus non‐ENE (HR, 4.9; P < 0.02), a positive lymph nodes (LN) percentage of ≥10% (HR, 4.2; P = 0.0002), and five or more positive LNs (HR, 4.9; P = 0.00004). Three‐year OS was significantly worse for AJCC 8th edition pN2 versus pN0 but not for 7th edition pN2 versus pN0 disease. Five‐year OS was significantly worse for positive versus negative surgical margins, AJCC 8th edition stage II versus I, and either microscopic or macroscopic ENE versus non‐ENE positive LNs. For 523 (71%) AJCC 8th edition stage I patients and for 283 (38%) patients who were pT1–T2, with negative margins, pN0–N1, with ≤4 pathologic LNs, without ENE, and with >20 LNs removed during neck dissection, the 3‐year OS rates were 93% and 95%, respectively, and the 5‐year OS rates were 91% and 95%, respectively. Conclusion In the context of the lack of detail and possible inaccuracies found in the NCDB, surgery alone for AJCC 8th edition stage I HPV + OPSCC, particularly pT1–T2, pN0–N1 with ≤4 pathologic LNs, without ENE, and with negative surgical margins has a high OS. Level of Evidence 4 Laryngoscope, 130:E423–E435, 2020

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Section: Introductionmentioning

confidence: 99%

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

et al. 2019

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“…Studies with larger HPV-related OPSCC NCDB cohorts did not examine LVI as a risk factor. 12,32 LVI is not included in AJCC eight edition staging 18,33 but has been identified as an adverse feature in the guidelines of the National Comprehensive Cancer Network and is used for risk group stratification in clinical trials, including ECOG 3311. 13,34 Our findings may support this area of investigation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Lymph Node Yield on Survival in Surgically Treated Oropharyngeal Squamous Cell Carcinoma

Gomez

Chang

Ceremsak

et al. 2020

Otolaryngol.--head neck surg.

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Objectives (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV-related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV-associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5-year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY <18, P = .004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29-0.70; P < .001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41-1.00), but the result was not statistically significant ( P = .052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV-related OPSCC is treated with up-front surgery.

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“…All three studies did not report survival outcomes specifically for N3 nodal disease and were therefore excluded from this review. The large prospective cohort study of 1126 patients with N3 disease analysed N2c and N3 patients as a single group, without specific survival outcomes for N3 disease alone. The study did report an OS hazard ratio of 1.64 for N3 nodal disease (95% CI 1.45‐1.84; P < .0001), demonstrating that patients with N3 disease have significantly worse survival than other subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…All three studies did not report survival outcomes specifically for N3 nodal disease and were therefore excluded from this review. The large prospective cohort study of 1126 patients with N3 disease 17 It is important to reiterate that any comparison between CRT and surgery + RT is difficult due to selection bias, as outlined above.…”

Section: Limitationsmentioning

confidence: 99%

Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases

Virk

Ingle

Podesta

et al. 2020

Clinical Otolaryngology

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Background: Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV)-positive HNSCC. Methods: We carried out a systematic search of MEDLINE and Embase for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis-free survival (DMFS), disease-free survival (DFS) or overall survival (OS) was assessed.Results: Nine studies met the inclusion criteria. Eight of these studies (N = 5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT and 2 on both.Four of these eight studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT. Patients treated with CRT achieved LC rates of 77%-94% at 2-3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three-year OS was better for HPV+ HNSCC (range, 55.2%-81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ vs HPV− and better survival in oropharyngeal cancers. Five-year DFS rates varied from 30% to 87%, and OS from 26.6% to 84%. For patients with non-CR, positive histology rates varied from 27.3% to 100%, with average positive histology rates of 27.3% in HPV+ patients with non-CR vs 60% for HPV− patients with non-CR. Conclusion:The current literature does not support the de-escalation of treatment with HPV− N3 disease. Observation of HPV+ patients who achieve a CR post-CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non-CR cohort.

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Primary surgery versus primary radiation‐based treatment for locally advanced oropharyngeal cancer

Abstract: 2c. Laryngoscope, 128:1353-1364, 2018.

Cited by 31 publications

References 33 publications

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

Impact of Lymph Node Yield on Survival in Surgically Treated Oropharyngeal Squamous Cell Carcinoma

Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases

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