Kyle Wang1, Terence Z Wong2, Robert J Amdur3, William M Mendenhall4, Nathan C Sheets5, Rebecca Green6, Brian D Thorp7, Samip N Patel8, Trevor G Hackman9, Adam M Zanation10, Mark C Weissler11, Bhishamjit S Chera12. 1. Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: kyle.wang@unchealth.unc.edu. 2. Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: terence_wong@med.unc.edu. 3. Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL, United States. Electronic address: amdurr@shands.ufl.edu. 4. Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL, United States. Electronic address: mendwm@shands.ufl.edu. 5. Department of Radiation Oncology, University of North Carolina Rex Hospital, Raleigh, NC, United States. Electronic address: nathan.sheets@unchealth.unc.edu. 6. Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: rebecca_green@med.unc.edu. 7. Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: bthorp@email.unc.edu. 8. Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: samip_patel@med.unc.edu. 9. Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: trevor_hackman@med.unc.edu. 10. Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: adam_zanation@med.unc.edu. 11. Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: mark_weissler@med.unc.edu. 12. Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, United States. Electronic address: bchera@med.unc.edu.
Abstract
OBJECTIVES: We evaluated patterns of nodal response and positive predictive value (PPV) of 3 month post-treatment PET in patients with HPV-associated oropharyngeal cancer treated on a multi-institutional de-intensification trial. MATERIALS AND METHODS: Eligibility criteria included: (1) T0-3, N0-2c, M0, (2) HPV+/p16+ oropharyngeal squamous cell carcinoma, and (3) ≤10 pack-years smoking or ≤30 pack-years and abstinent ≥5 years. Patients received 60 Gy radiation alone (T0-2, N0-1) or with concurrent weekly cisplatin 30 mg/m2 and surveillance PET three months post-radiation. Nodal responses were categorized as complete (CR), equivocal (ER), or incomplete (IR) using both local and central radiographic review. A "true positive" was ER/IR with clinical/radiographic progression or positive pathology. RESULTS: 79 node-positive pts (84% N2) were analyzed. Distribution of nodal CR, ER, and IR was 44 (56%), 27 (34%), and 8 (10%), respectively. 29 (37%) had ER/IR in pre-treatment node-positive neck levels, whereas 14 (18%) had ER/IR in pre-treatment node-negative levels. Of patients with ER/IR, 5 were observed clinically, 19 received repeat imaging, and 11 received either biopsy (1) or neck dissection (10). The PPV was 9% for ER/IR and 13% for IR, with 3 patients found to have persistent disease on neck dissection. There was no difference in nodal relapse rate in patients with nodal CR vs. nodal ER/IR. CONCLUSION: Post-treatment PET may not accurately predict the presence of persistent disease in patients with favorable-risk oropharynx cancer. These results support close surveillance rather than surgical evaluation in most favorable-risk patients.
OBJECTIVES: We evaluated patterns of nodal response and positive predictive value (PPV) of 3 month post-treatment PET in patients with HPV-associated oropharyngeal cancer treated on a multi-institutional de-intensification trial. MATERIALS AND METHODS: Eligibility criteria included: (1) T0-3, N0-2c, M0, (2) HPV+/p16+ oropharyngeal squamous cell carcinoma, and (3) ≤10 pack-years smoking or ≤30 pack-years and abstinent ≥5 years. Patients received 60 Gy radiation alone (T0-2, N0-1) or with concurrent weekly cisplatin 30 mg/m2 and surveillance PET three months post-radiation. Nodal responses were categorized as complete (CR), equivocal (ER), or incomplete (IR) using both local and central radiographic review. A "true positive" was ER/IR with clinical/radiographic progression or positive pathology. RESULTS: 79 node-positive pts (84% N2) were analyzed. Distribution of nodal CR, ER, and IR was 44 (56%), 27 (34%), and 8 (10%), respectively. 29 (37%) had ER/IR in pre-treatment node-positive neck levels, whereas 14 (18%) had ER/IR in pre-treatment node-negative levels. Of patients with ER/IR, 5 were observed clinically, 19 received repeat imaging, and 11 received either biopsy (1) or neck dissection (10). The PPV was 9% for ER/IR and 13% for IR, with 3 patients found to have persistent disease on neck dissection. There was no difference in nodal relapse rate in patients with nodal CR vs. nodal ER/IR. CONCLUSION: Post-treatment PET may not accurately predict the presence of persistent disease in patients with favorable-risk oropharynx cancer. These results support close surveillance rather than surgical evaluation in most favorable-risk patients.
Authors: Robin J D Prestwich; Moses Arunsingh; Jim Zhong; Karen E Dyker; Sriram Vaidyanathan; Andrew F Scarsbrook Journal: Eur Radiol Date: 2019-08-29 Impact factor: 5.315
Authors: Travis C Salzillo; Nicolette Taku; Kareem A Wahid; Brigid A McDonald; Jarey Wang; Lisanne V van Dijk; Jillian M Rigert; Abdallah S R Mohamed; Jihong Wang; Stephen Y Lai; Clifton D Fuller Journal: Semin Radiat Oncol Date: 2021-10 Impact factor: 5.421
Authors: Shanmugappiriya Sivarajah; Andre Isaac; Tim Cooper; Han Zhang; Lakshmi Puttagunta; Jonathan Abele; Vincent Biron; Jeffery Harris; Hadi Seikaly; Daniel A O' Connell Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-11-01 Impact factor: 6.223