PURPOSE: To define human papillomavirus (HPV) -positive oropharyngeal cancers (OPC) suitable for treatment deintensification according to low risk of distant metastasis (DM). PATIENTS AND METHODS: OPC treated with radiotherapy (RT) or chemoradiotherapy (CRT) from 2001 to 2009 were included. Outcomes were compared for HPV-positive versus HPV-negative patients. Univariate and multivariate analyses identified outcome predictors. Recursive partitioning analysis (RPA) stratified the DM risk. RESULTS: HPV status was ascertained in 505 (56%) of 899 consecutive OPCs. Median follow-up was 3.9 years. HPV-positive patients (n = 382), compared with HPV-negative patients (n = 123), had higher local (94% v 80%, respectively, at 3 years; P < .01) and regional control (95% v 82%, respectively; P < .01) but similar distant control (DC; 90% v 86%, respectively; P = .53). Multivariate analysis identified that HPV negativity (hazard ratio [HR], 2.9; 95% CI, 2.0 to 5.0), N2b-N3 (HR, 2.9; 95% CI, 1.8 to 4.9), T4 (HR, 1.8; 95% CI, 1.2 to 2.9), and RT alone (HR, 1.8; 95% CI, 1.1 to 2.5) predicted a lower recurrence-free survival (RFS; all P < .01). Smoking pack-years > 10 reduced overall survival (HR, 1.72; 95% CI, 1.1 to 2.7; P = .03) but did not impact RFS (HR, 1.1; 95% CI, 0.7 to 1.9; P = .65). RPA segregated HPV-positive patients into low (T1-3N0-2c; DC, 93%) and high DM risk (N3 or T4; DC, 76%) groups and HPV-negative patients into different low (T1-2N0-2c; DC, 93%) and high DM risk (T3-4N3; DC, 72%) groups. The DC rates for HPV-positive, low-risk N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT, but the rate was lower in the N2c subset managed by RT alone (73% v 92% for CRT; P = .02). CONCLUSION: HPV-positive T1-3N0-2c patients have a low DM risk, but N2c patients from this group have a reduced DC when treated with RT alone and seem less suited for deintensification strategies that omit chemotherapy.
PURPOSE: To define human papillomavirus (HPV) -positive oropharyngeal cancers (OPC) suitable for treatment deintensification according to low risk of distant metastasis (DM). PATIENTS AND METHODS: OPC treated with radiotherapy (RT) or chemoradiotherapy (CRT) from 2001 to 2009 were included. Outcomes were compared for HPV-positive versus HPV-negative patients. Univariate and multivariate analyses identified outcome predictors. Recursive partitioning analysis (RPA) stratified the DM risk. RESULTS:HPV status was ascertained in 505 (56%) of 899 consecutive OPCs. Median follow-up was 3.9 years. HPV-positive patients (n = 382), compared with HPV-negative patients (n = 123), had higher local (94% v 80%, respectively, at 3 years; P < .01) and regional control (95% v 82%, respectively; P < .01) but similar distant control (DC; 90% v 86%, respectively; P = .53). Multivariate analysis identified that HPV negativity (hazard ratio [HR], 2.9; 95% CI, 2.0 to 5.0), N2b-N3 (HR, 2.9; 95% CI, 1.8 to 4.9), T4 (HR, 1.8; 95% CI, 1.2 to 2.9), and RT alone (HR, 1.8; 95% CI, 1.1 to 2.5) predicted a lower recurrence-free survival (RFS; all P < .01). Smoking pack-years > 10 reduced overall survival (HR, 1.72; 95% CI, 1.1 to 2.7; P = .03) but did not impact RFS (HR, 1.1; 95% CI, 0.7 to 1.9; P = .65). RPA segregated HPV-positive patients into low (T1-3N0-2c; DC, 93%) and high DM risk (N3 or T4; DC, 76%) groups and HPV-negative patients into different low (T1-2N0-2c; DC, 93%) and high DM risk (T3-4N3; DC, 72%) groups. The DC rates for HPV-positive, low-risk N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT, but the rate was lower in the N2c subset managed by RT alone (73% v 92% for CRT; P = .02). CONCLUSION:HPV-positive T1-3N0-2c patients have a low DM risk, but N2c patients from this group have a reduced DC when treated with RT alone and seem less suited for deintensification strategies that omit chemotherapy.
Authors: Carole Fakhry; Qiang Zhang; Phuc Felix Nguyen-Tân; David I Rosenthal; Randal S Weber; Louise Lambert; Andy M Trotti; William L Barrett; Wade L Thorstad; Christopher U Jones; Sue S Yom; Stuart J Wong; John A Ridge; Shyam S D Rao; James A Bonner; Eric Vigneault; David Raben; Mahesh R Kudrimoti; Jonathan Harris; Quynh-Thu Le; Maura L Gillison Journal: J Clin Oncol Date: 2017-08-04 Impact factor: 44.544
Authors: M Reuschenbach; S Wagner; N Würdemann; S J Sharma; E-S Prigge; M Sauer; A Wittig; C Wittekindt; M von Knebel Doeberitz; J P Klussmann Journal: HNO Date: 2016-07 Impact factor: 1.284
Authors: Jeffrey M Vainshtein; Dominic H Moon; Felix Y Feng; Douglas B Chepeha; Avraham Eisbruch; Matthew H Stenmark Journal: Int J Radiat Oncol Biol Phys Date: 2015-04-01 Impact factor: 7.038
Authors: Seija I Vento; Lauri Jouhi; Hesham Mohamed; Caj Haglund; Antti A Mäkitie; Timo Atula; Jaana Hagström; Laura K Mäkinen Journal: Virchows Arch Date: 2018-05-02 Impact factor: 4.064
Authors: Moonef Alotaibi; Valeria Valova; Toni HÄnsel; Carmen Stromberger; Grzegorz Kofla; Heidi Olze; Iris Piwonski; Andreas Albers; Sebastian Ochsenreither; Annekatrin Coordes Journal: In Vivo Date: 2021 Mar-Apr Impact factor: 2.155
Authors: Jeffrey M Vainshtein; Matthew E Spector; Mohannad Ibrahim; Carol R Bradford; Gregory T Wolf; Matthew H Stenmark; Francis P Worden; Jonathan B McHugh; Mark E Prince; Thomas Carey; Douglas B Chepeha; Avraham Eisbruch Journal: Head Neck Date: 2015-07-15 Impact factor: 3.147