Radiation therapy (with or without neck surgery) for phenotypic human papillomavirus–associated oropharyngeal cancer

Abstract

Background Favorable outcomes for HPV-associated oropharyngeal cancer (OPC) has led to interest in identifying a subgroup of patients with the lowest risk of disease recurrence following therapy. De-intensification of therapy for this group may result in survival outcomes that are similar to current therapy but with less toxicity. To advance this effort, we analyzed the outcomes of OPC patients treated with and without systemic therapy. Methods This is a retrospective study of oropharyngeal cancer patients treated between 1985–2012. Criteria for inclusion were ≤ 10 pack-years of cigarette smoking and stage III and IVA limited to T1-3, N1-N2b and T3N0. Survival analysis was performed with the primary endpoint of progression-free survival (PFS). Results The cohort included 857 patients. Systemic therapy was given to 439 patients (51%). Median survival was 80 months. The 2-year PFS rates was 91%. Limiting analysis to 324 patients irradiated without systemic therapy, the 2- and 5- year PFS rates were 90% and 85%, respectively. Further, for these 324 patients the 5- year PFS rates for T1, T2, and T3 disease were 90%, 83%, and 70%, respectively. The 5-year PFS rate for patients treated with systemic therapy for T3 disease was 77% (p = .07). Conclusions Using the low-risk definition currently established in cooperative trials, our patients had a 2-year PFS rates approximating 90%. When evaluating patients treated with radiation alone, we did not observe a compromise in this high rate of PFS, which is higher than the 2-year PFS thresholds used in current cooperative trials.

Human papilloma virus‐associated squamous cell carcinoma of the larynx in an 18‐year‐old woman

“…Minimally invasive surgery as the only treatment modality seems to be a valid option for localized, superficial HPV‐associated SCC of the larynx. This is fully consistent with the de‐intensification therapy concept proposed by, but not yet validated by the literature …”

Enhancing radiosensitization in EphB4 receptor-expressing Head and Neck Squamous Cell Carcinomas

“…In CUHN022 tumor, radiosensitization due to EphB4 targeting was observed after radiation dose de-escalation. HPV-positive tumors are known to be less malignant234 and ongoing trials are focused on treatment de-intensification35363738. Our results with CUHN022 show no effect of EphB4 targeting on radiosensitization with high dose of radiation, but a difference was noticed when the radiation dose was decreased.…”

Transoral Robotic Surgery for Oropharyngeal Cancer

“…In general, adjuvant radiation is delivered in the presence of positive margins and adverse features in the primary cancer or the neck dissection specimen [33]. However, several prospective data sets have questioned the value of concurrent CRT in the adjuvant setting for HPV-positive tumours [34,35], and de-intensification regimes are being tested in ongoing trials.…”