Thomas J Galloway1, Qiang Ed Zhang2, Phuc Felix Nguyen-Tan3, David I Rosenthal4, Denis Soulieres3, André Fortin5, Craig L Silverman6, Megan E Daly7, John A Ridge8, J Alexander Hammond9, Quynh-Thu Le10. 1. Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: thomas.galloway@fccc.edu. 2. NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania. 3. Centre Hospitalier de l'Universite de Montreal-Notre Dame, Montréal, Québec, Canada. 4. University of Texas MD Anderson Cancer Center, Houston, Texas. 5. L Hotel-Dieu de Quebec, Québec City, Québec, Canada. 6. The James Brown Cancer Center-University of Louisville, Louisville, Kentucky. 7. University of California Davis Medical Center, Sacramento, California. 8. Fox Chase Cancer Center, Philadelphia, Pennsylvania. 9. London Regional Cancer Program, London, Ontario, Canada. 10. Stanford University Medical Center, Stanford, California.
Abstract
PURPOSE: To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. METHODS AND MATERIALS: Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. RESULTS: Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n=69; p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P=.71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P=.42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P=.02) and was associated with a reduced incidence of local-regional failure (hazard ratio 0.33, P=.003). On multivariate analysis of local-regional failure, a test for interaction between pCR and p16 status was not significant (P=.37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P=.42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. CONCLUSIONS: Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.
PURPOSE: To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. METHODS AND MATERIALS: Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. RESULTS: Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n=69; p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P=.71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P=.42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P=.02) and was associated with a reduced incidence of local-regional failure (hazard ratio 0.33, P=.003). On multivariate analysis of local-regional failure, a test for interaction between pCR and p16 status was not significant (P=.37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P=.42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. CONCLUSIONS:Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.
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