Nader Sadeghi1,2, Marco A Mascarella1,3, Sarah Khalife1, Agnihotram V Ramanakumar2,3, Keith Richardson1, Arjun S Joshi4, Reza Taheri5, Andrew Fuson4, Nathaniel Bouganim6, Robert Siegel7. 1. Department of Otolaryngology - Head and Neck Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada. 2. Research Institute of McGill University Health Center, McGill University, Montreal, Quebec, Canada. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. 4. Department of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA. 5. Department of Diagnostic Radiology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA. 6. Department of Oncology, McGill University Health Center, McGill University, Montreal, Quebec, Canada. 7. Department of Hematology and Oncology, George Washington University, Washington, District of Columbia, USA.
Abstract
BACKGROUND: Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery-based de-escalation, is under investigation for treatment of HPV-associated oropharynx cancer (OPC). METHODS: Prospective cohort of patients with non-metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease-free survival (DFS). RESULTS: Fifty-five patients were treated with NAC + S and 142 with CCRT. Stage-matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5-year DFS in the NAC + S group was 96.1% (95% CI 90.8-100) compared to 67.6% (95% CI 50.7-84.5) for CCRT (P = .01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent (P < .0001). CONCLUSION: NAC + S may be a novel approach for HPV-associated OPC as it provides lower feeding tube dependence and improved survival compared to stage-matched patients undergoing CCRT.
BACKGROUND: Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery-based de-escalation, is under investigation for treatment of HPV-associated oropharynx cancer (OPC). METHODS: Prospective cohort of patients with non-metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease-free survival (DFS). RESULTS: Fifty-five patients were treated with NAC + S and 142 with CCRT. Stage-matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5-year DFS in the NAC + S group was 96.1% (95% CI 90.8-100) compared to 67.6% (95% CI 50.7-84.5) for CCRT (P = .01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent (P < .0001). CONCLUSION:NAC + S may be a novel approach for HPV-associated OPC as it provides lower feeding tube dependence and improved survival compared to stage-matched patients undergoing CCRT.