Treatment Preferences in Human Papillomavirus-Associated Oropharyngeal Cancer

Windon, Melina J.; D’Souza, Gypsyamber; Fakhry, Carole

doi:10.2217/fon-2018-0063

Cited by 22 publications

(24 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results support that cure should be aggressively pursued during treatment, as it is strongly prioritized by patients. The common functional endpoint of swallow in most deintensification trials 22 implies well-being among survivors rests largely on swallowing, whereas our results demonstrate that patients' non-oncologic priorities widely vary, consistent with prior studies. 6,7 Swallow is indeed important regardless of HPV tumor status, but for many patients, other non-oncologic goals take precedence.…”

Section: Discussionsupporting

confidence: 88%

Priorities, concerns, and regret among patients with head and neck cancer

Windon¹,

D’Souza

Faraji³

et al. 2019

Cancer

Self Cite

View full text Add to dashboard Cite

Background: In the era of deintensification, little data is available regarding patients' treatment preferences. This study evaluates treatment-related priorities, concerns and regret among head and neck squamous cell cancer (HNSCC) patients.Methods: Patients with HNSCC (n=150) ranked the importance of ten non-oncologic treatment goals, relative to the oncologic goals cure and survival. Level of concern regarding 11 issues and decision regret was recorded. Median rank was reported overall, and factors associated with odds of rank as a top three priority were modeled using logistic regression.Results: Among the treatment effects analyzed, odds of being a top three priority was especially high for cure (odds 9.17, 95% CI 5.05-16.63), followed by survival and swallow (1.26, 95% CI 0.88-1.80 and 0.85, 95% CI 0.59-1.21, respectively). Prioritization of cure, survival and swallow was similar by human papillomavirus (HPV) tumor status. By increasing decade of age, older participants were significantly less likely than younger to prioritize survival (odds ratio, 0.72; 95%CI, 0.52-1.00). Concern regarding mortality (p=0.04

show abstract

Section: Discussionsupporting

confidence: 88%

Priorities, concerns, and regret among patients with head and neck cancer

Windon¹,

D’Souza

Faraji³

et al. 2019

Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…Chemoradiation has demonstrated impressive results, with a 5-year overall survival of 95% in HPV+ patients [47]. In developing countries where there is a shortage of radiation facilities, the majority of patients are subjected to surgery [48]. However, patients affected with HPV+ disease are traditionally younger with a low burden of co-morbidities and have a significant survival advantage compared to patients with HPV− OSCC.…”

Section: Treatment and De-escalation Strategiesmentioning

confidence: 99%

Special Issue about Head and Neck Cancers: HPV Positive Cancers

Economopoulou

Kotsantis

Psyrri

2020

IJMS

View full text Add to dashboard Cite

The oropharynx has become the leading primary site for Human Papilloma Virus (HPV)-associated head and neck cancer. HPV positive oropharyngeal squamous cell carcinoma (HPV+ OSCC) has emerged as an epidemic not easily recognized by many physicians, resulting in delays in diagnosis and management. HPV+ OSCC traditionally refers to younger, healthier patients with high economic status and high-risk sexual behavior and is related to improved prognosis. De-intensification strategies are being evaluated in ongoing clinical trials and if validated, might help spare severe morbidity associated with current cisplatin-based chemoradiotherapy, which is the standard of care for all patients with locally advanced head and neck cancer. On the other hand, whether HPV status represents an important prognostic factor for non-oropharyngeal sites remains to be elucidated.

show abstract

“…One treatment deintensification approach is definitive surgery for select patients with early-stage HPV1 OPSCC. [1][2][3] The decision to offer a primary surgical approach for HPV1 OPSCC is balanced by the likelihood of subsequent adjuvant therapies that contribute multiplicative rather than additive morbidity. 4 Therefore, when surgery is offered, ideally it is the only modality or one that is followed by only adjuvant radiation (aRT) and not adjuvant chemoradiation (aCRT).…”

mentioning

confidence: 99%

Predicting Adverse Histopathology and Need for Postsurgical Adjuvant Therapy for Human Papilloma Virus–Associated Oropharynx Carcinoma

Ochoa

Stanford-Moore

Fakhry

et al. 2021

Otolaryngol.--head neck surg.

Self Cite

View full text Add to dashboard Cite

Objective For human papillomavirus–associated oropharynx carcinoma treated with definitive surgery, we aimed to find predictors of adverse histopathology indicating the possible need for adjuvant therapy. Study Design Retrospective review. Setting National Cancer Database. Methods We analyzed 2347 eligible patients from 2010 to 2015. We evaluated (1) the ability of clinical nodal staging and extranodal extension designation per the AJCC, seventh edition (American Joint Committee on Cancer), to predict histopathology and (2) the likelihoods for adverse postsurgery histopathology by common clinical stages. Results Clinical nodal staging predicted pathologic nodal staging 65% of the time, with 24% (569/2347) being upstaged and 11% (251/2347) being downstaged. In patients with cN+ disease, clinical extranodal extension distinction had the following accuracy for pathologic extranodal extension: positive predictive value, 81% (88/109); negative predictive value, 73.1% (505/691); sensitivity, 32.1% (88/274); and specificity, 96.0% (505/526). Patients with cT1-2, N0-N2c, without clinical extranodal extension had the following proportions of pN2+ without pathologic extranodal extension (indicating consideration for adjuvant radiation): cN0, 11%; cN1, 31%; cN2a, 67% (8% downstaged); cN2b, 66% (6% downstaged); and cN2c, 35% (17% downstaged). From this group, patients had the following proportions of pathologic extranodal extension (indicating consideration for adjuvant chemoradiation): cN0, 6%; cN1, 20%; cN2a, 27%; cN2b, 28%; and cN2c, 48%. Conclusion For human papillomavirus–associated oropharynx carcinoma, nodal clinical staging per the American Joint Committee on Cancer, seventh edition, predicts pathologic stage about two-thirds of the time, leading to up- and downstaging. Clinical extranodal extension assessment has low sensitivity and moderate predictive capability. With careful selection, definitive surgery can allow patients to often avoid adjuvant chemotherapy and sometimes avoid adjuvant radiation.

show abstract

Treatment Preferences in Human Papillomavirus-Associated Oropharyngeal Cancer

Cited by 22 publications

References 80 publications

Priorities, concerns, and regret among patients with head and neck cancer

Priorities, concerns, and regret among patients with head and neck cancer

Special Issue about Head and Neck Cancers: HPV Positive Cancers

Predicting Adverse Histopathology and Need for Postsurgical Adjuvant Therapy for Human Papilloma Virus–Associated Oropharynx Carcinoma

Contact Info

Product

Resources

About