Ryan S Jackson1, Parul Sinha2, Joseph Zenga2, Dorina Kallogjeri2,3, Jasmina Suko2,3, Eliot Martin4, Eric J Moore4, Bruce H Haughey5. 1. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA. jackson.ryan@wust.edu. 2. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA. 3. Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA. 4. Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA. 5. Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health and Florida Hospital Cancer Institute, Celebration, FL, USA.
Abstract
BACKGROUND: With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma. METHODS: A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4). RESULTS: The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6). CONCLUSIONS: Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
BACKGROUND: With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma. METHODS: A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4). RESULTS: The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6). CONCLUSIONS: Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
Authors: Bhavna Kumar; Michael J Cipolla; Matthew O Old; Nicole V Brown; Stephen Y Kang; Peter T Dziegielewski; Kasim Durmus; Enver Ozer; Amit Agrawal; Ricardo L Carrau; David E Schuller; Marino E Leon; Quintin Pan; Pawan Kumar; Valerie Wood; Jessica Burgers; Paul E Wakely; Theodoros N Teknos Journal: Head Neck Date: 2015-12-23 Impact factor: 3.147
Authors: Shao Hui Huang; Bayardo Perez-Ordonez; Ilan Weinreb; Andrew Hope; Christine Massey; John N Waldron; John Kim; Andrew J Bayley; Bernard Cummings; B C John Cho; Jolie Ringash; Laura A Dawson; Lillian L Siu; Eric Chen; Jonathan Irish; Patrick Gullane; Angela Hui; Fei-Fei Liu; Xiaowei Shen; Wei Xu; Brian O'Sullivan Journal: Oral Oncol Date: 2012-08-20 Impact factor: 5.337
Authors: David G Grant; Michael L Hinni; John R Salassa; William C Perry; Richard E Hayden; John D Casler Journal: Arch Otolaryngol Head Neck Surg Date: 2009-12
Authors: John R de Almeida; Ryan Li; J Scott Magnuson; Richard V Smith; Eric Moore; Georges Lawson; Marc Remacle; Ian Ganly; Dennis H Kraus; Marita S Teng; Brett A Miles; Hilliary White; Umamaheswar Duvvuri; Robert L Ferris; Vikas Mehta; Krista Kiyosaki; Edward J Damrose; Steven J Wang; Michael E Kupferman; Yoon Woo Koh; Eric M Genden; F Christopher Holsinger Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-12 Impact factor: 6.223
Authors: John M Kaczmar; Kay See Tan; Daniel F Heitjan; Alexander Lin; Peter H Ahn; Jason G Newman; Christopher H Rassekh; Ara A Chalian; Bert W O'Malley; Roger B Cohen; Gregory S Weinstein Journal: Head Neck Date: 2015-04-06 Impact factor: 3.147
Authors: Mark D Wilkie; Navdeep S Upile; Andrew S Lau; Stephen P Williams; Jon Sheard; Tim R Helliwell; Max Robinson; Jennifer Rodrigues; Krishna Beemireddy; Huw Lewis-Jones; Rebecca Hanlon; David Husband; Aditya Shenoy; Nicholas J Roland; Shaun R Jackson; Fazilet Bekiroglu; Sankalap Tandon; Jeffrey Lancaster; Terence M Jones Journal: Head Neck Date: 2016-04-04 Impact factor: 3.147