Yuki Saito1, Ryuichi Hayashi2, Yoshiyuki Iida3, Takatsugu Mizumachi4, Takashi Fujii5, Fumihiko Matsumoto6, Takeshi Beppu7, Masafumi Yoshida1, Hirotaka Shinomiya8, Ryosuke Kamiyama9, Mutsukazu Kitano10, Kazuhiko Yokoshima11, Yasushi Fujimoto12, Takanori Hama13, Taku Yamashita14, Kenji Okami15, Kouki Miura16, Takuo Fujisawa17, Daisuke Sano18, Hisayuki Kato19, Shujiro Minami20, Masashi Sugasawa21, Muneyuki Masuda22, Ichiro Ota23, Shigemichi Iwae24, Ryo Kawata25, Nobuya Monden26, Takayuki Imai27, Takahiro Asakage28, Masafumi Okada29, Takanori Yoshikawa30, Kensuke Tanioka31, Megumi Kitayama30, Mariko Doi32, Satoshi Fujii33,34, Masato Fujii20, Nobuhiko Oridate18, Munenaga Nakamizo11, Seiichi Yoshimoto6, Akihiro Homma4, Ken-Ichi Nibu8, Katsunari Yane35. 1. Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan. 2. Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan. 3. Department of Head and Neck Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. 4. Department of Otorhinolaryngology, Hokkaido University Hospital, Hokkaido, Japan. 5. Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan. 6. Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan. 7. Department of Head and Neck Surgery, Saitama Cancer Center, Saitama, Japan. 8. Department of Otolaryngology-Head and Neck Surgery, Kobe University School of Medicine, Hyogo, Japan. 9. Department of Head and Neck Surgery, Cancer Institute Hospital, Tokyo, Japan. 10. Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan. 11. Department of Otorhinolaryngology, Nippon Medical School Hospital, Tokyo, Japan. 12. Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 13. Department of Otolaryngology, Jikei University Hospital, Tokyo, Japan. 14. Department of Otolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan. 15. Department of Otolaryngology, Tokai University Hospital, Kanagawa, Japan. 16. Department of Head and Neck Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. 17. Department of Otolaryngology, Kansai Medical University, Osaka, Japan. 18. Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, School of Medicine, Kanagawa, Japan. 19. Department of Otolaryngology & Head and Neck Surgery, Fujita Health University School of Medicine, Aichi, Japan. 20. Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 21. Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama, Japan. 22. Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. 23. Department of Otolaryngology, Nara Medical University Hospital, Nara, Japan. 24. Department of Head and Neck Surgery, Hyogo Cancer Center, Hyogo, Japan. 25. Department of Otolaryngology, Osaka Medical College Hospital, Osaka, Japan. 26. Department of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan. 27. Department of Head and Neck Surgery, Miyagi Cancer Center, Miyagi, Japan. 28. Department of Head and Neck Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan. 29. University Hospital Medical Information Network, Tokyo, Japan. 30. Data Center Department, Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan. 31. Faculty of life and biomedical sciences, Doshisha Univeristy, Kyoto, Japan. 32. Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan. 33. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan. 34. Department of Molecular Pathology, Yokohama City University School of Medicine, Kanagawa, Japan. 35. Department of Otorhinolaryngology, Kindai University Nara Hospital, Nara, Japan.
Abstract
BACKGROUND: Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .
BACKGROUND: Although the American Joint Committee on CancerTNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .