Anouchka Modesto1, Thibaut Galissier2, Amélie Lusque3, Jean-Pierre Delord4, Emmanuelle Uro-Coste2, Jérôme Sarini5, Frédéric Mouchet6, Raphaël Lopez7, Anne Laprie8, Pierre Graff8, Sébastien Vergez5, Michel Rives8. 1. Radiation Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France. modesto.anouchka@iuct-oncopole.fr. 2. Pathology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France. 3. Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France. 4. Medical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France. 5. Head and Neck Surgery Department, Centre Hospitalo-Universitaire de Larrey, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France. 6. Head and Neck Surgery Department, Clinique Ambroise Paré, Toulouse, France. 7. Maxillo-facial Surgery Department, CHU Toulouse Purpan, 1 place Baylac, Toulouse, France. 8. Radiation Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France.
Abstract
BACKGROUND: The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown. RESULTS: Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3‑year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002. CONCLUSION: Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.
BACKGROUND: The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown. RESULTS: Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3‑year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002. CONCLUSION: Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.
Entities:
Keywords:
Genes, p16; Human papillomavirus; Radiotherapy; Risk factors; Survival
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