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Stock GT, Bonadio RRCC, de Castro G. De-escalation treatment of human papillomavirus-positive oropharyngeal squamous cell carcinoma: an evidence-based review for the locally advanced disease. Curr Opin Oncol 2019; 30:146-151. [PMID: 29474271 DOI: 10.1097/cco.0000000000000441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Oropharyngeal cancer (OPC) incidence is increasing worldwide, especially in developed countries where it seems to be etiologically related to the elevating rates of high-risk human papillomavirus (HPV) infection. Considered a distinct disease because of its weak correlation with the traditional risk factors (tobacco use and alcohol), it has different patterns of survival outcomes, locoregional and distant failure, generally with better prognosis independently of the treatment. The standard therapeutic approach for locally advanced (LA) OPCs includes radiation therapy with concurrent chemotherapy, resulting in severe toxicities with negative impacts in quality of life (QoL). Considering this, efforts emerged to de-intensify treatment modalities in selected patients and achieve less morbidity while maintaining the favorable outcome. RECENT FINDINGS Several de-escalated treatment strategies for HPV-related OPCs have been proposed to date with some of them being assessed in ongoing clinical trials. The main approaches encompass: minimally invasive surgery and reduced adjuvant treatment; antiepidermal growth factor receptor (EGFR) monoclonal antibodies (mAbs) as alternative to chemotherapy concurrent with radiation therapy; adjusted radiation therapy dose intensity in responders to induction chemotherapy; reduced-dose radiation therapy. SUMMARY There is still a lack of evidence to support de-intensification treatment for HPV-positive LA-OPC in clinical practice, and it remains investigational. Ongoing trials based on risk stratification might identify subgroups with greatest benefits of de-escalation strategies, reducing treatment morbidity without constituting the favorable prognosis.
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Affiliation(s)
- Gustavo T Stock
- Medical Oncology, Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Noor A, Mintz J, Patel S, Bajic N, Boase S, Sethi N, Foreman A, Krishnan S, Hodge J. Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol 2019; 63:500-509. [DOI: 10.1111/1754-9485.12888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony Noor
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Jack Mintz
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Sandy Patel
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Nicholas Bajic
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Sam Boase
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Neeraj Sethi
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Andrew Foreman
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - John‐Charles Hodge
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
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Davis RJ, Rettig E, Aygun N, Rooper L, D'Souza G, Eisele DW, Fakhry C. From presumed benign neck masses to delayed recognition of human papillomavirus-positive oropharyngeal cancer. Laryngoscope 2019; 130:392-397. [PMID: 30950517 DOI: 10.1002/lary.27946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/07/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe patients with delayed diagnosis of human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC) after initial incorrect diagnosis of branchial cleft cyst or nondiagnostic workup of unilateral neck mass. STUDY DESIGN Retrospective case series. METHODS Patients with delayed diagnosis of HPV-OPC after initial nondiagnostic workup for unilateral neck mass were eligible. Medical record abstraction was performed to describe clinical characteristics at initial presentation and later diagnosis of HPV-OPC. To estimate nodal growth rates, the short axis diameter of the lymph nodes was determined from imaging reports. RESULTS Six patients met eligibility criteria. After a median interval of 42 months (range, 3 months-7 years) from initial presentation with unilateral neck mass, patients were diagnosed with HPV-OPC. At the time of HPV-OPC diagnosis, five were AJCC eighth edition overall stage I, and one was stage II. Primary tumors were T0 or T1 in the majority (83.3%, n = 5). Among five patients with available serial imaging, despite diagnostic delay, three of five still had a single lymph node without involvement of additional nodes, whereas the remaining two developed additional suspicious nodes (ipsilateral and contralateral). Two of five developed evidence of extranodal extension. Median lymph node growth was 9.5% per year (range, -6% to 32%). CONCLUSIONS Although the natural history of HPV-OPC is not well understood, this case series suggests that it can be slow growing and mimic benign processes, leading to diagnostic delays. Adults presenting with neck masses should undergo complete diagnostic evaluation. LEVEL OF EVIDENCE 4 Laryngoscope, 130:392-397, 2020.
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Affiliation(s)
- Ruth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nafi Aygun
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
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Abstract
Oropharyngeal carcinoma associated with the human papillomavirus is increasing in incidence and represents a unique head and neck disease with favorable treatment outcomes. This review evaluates the evolving role of radiotherapy in regional management with an overall goal of treatment de-escalation in the appropriate patient. Determining the optimal approach and selection factors for treatment de-escalation is under active investigation. Response to induction chemotherapy, refining adverse pathologic factors after a primary surgical approach, decreasing radiation dose with or without chemotherapy in the definitive or adjuvant settings as well as more selective nodal level irradiation all are current strategies for treatment de-escalation. This review details the likely changes in regional radiotherapy management for oropharyngeal carcinoma in the modern human papillomavirus era and discusses future approaches to patient selection with the goal of reducing toxicities while maintaining function preservation and quality of life in group of patients who are younger and healthier than traditional head and neck cancer patients.
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Affiliation(s)
- Moses Tam
- Department of Radiation Oncology, New York University Langone Health, New York, NY.
| | - Kenneth Hu
- Department of Radiation Oncology, New York University Langone Health, New York, NY
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Neck management in head and neck squamous cell carcinomas: where do we stand? Med Oncol 2019; 36:40. [DOI: 10.1007/s12032-019-1265-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
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Geiger JL, Ku JA. Postoperative Treatment of Oropharyngeal Cancer in the Era of Human Papillomavirus. Curr Treat Options Oncol 2019; 20:20. [DOI: 10.1007/s11864-019-0620-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Albergotti WG, Schwarzbach HL, Abberbock S, Ferris RL, Johnson JT, Duvvuri U, Kim S. Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus-Positive Oropharyngeal Carcinoma. JAMA Otolaryngol Head Neck Surg 2019; 143:1236-1243. [PMID: 29075776 DOI: 10.1001/jamaoto.2017.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hannah L Schwarzbach
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shira Abberbock
- Biostatistics Facility at the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonas T Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Elicin O, Broglie MA, Fankhauser N, Stoeckli SJ, Pasche P, Reinhard A, Bongiovanni M, Huber GF, Morand GB, Soltermann A, Arnold A, Dettmer MS, Arnoux A, Stauffer E, Espeli V, Martucci F, Aebersold DM, Giger R. Comparison of contemporary staging systems for oropharynx cancer in a surgically treated multi‐institutional cohort. Head Neck 2018; 41:1395-1402. [DOI: 10.1002/hed.25574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University HospitalUniversity of Bern Bern Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM)University of Bern Bern Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
| | - Philippe Pasche
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of Lausanne Lausanne Switzerland
| | - Antoine Reinhard
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of Lausanne Lausanne Switzerland
| | - Massimo Bongiovanni
- Service of Clinical PathologyLausanne University Hospital, Institute of Pathology Lausanne Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Grégoire B. Morand
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Alex Soltermann
- Institute of Surgical PathologyUniversity Hospital of Zurich Zurich Switzerland
| | - Andreas Arnold
- Department of Otorhinolaryngology, Head and Neck SurgeryInselspital, Bern University Hospital Bern Switzerland
| | | | - André Arnoux
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital Aarau Aarau Switzerland
| | | | - Vittoria Espeli
- Oncology Institute of Southern Switzerland (IOSI) Bellinzona Switzerland
| | - Francesco Martucci
- Department of RadiooncologyOncology Institute of Southern Switzerland (IOSI) Bellinzona Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University HospitalUniversity of Bern Bern Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck SurgeryInselspital, Bern University Hospital Bern Switzerland
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Bhattasali O, Thompson LDR, Schumacher AJ, Iganej S. Radiographic nodal prognostic factors in stage I HPV-related oropharyngeal squamous cell carcinoma. Head Neck 2018; 41:398-402. [PMID: 30552839 DOI: 10.1002/hed.25504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The updated AJCC Cancer Staging Manual groups all p16-positive oropharyngeal squamous cell carcinoma (OPSCC) with unilateral nodal involvement within 6 cm into the new clinical N1 classification, consolidating a heterogeneous group of disease with varying radiographic findings. METHODS A central radiological review was conducted identifying 233 patients with stage I node-positive (cT1-2N1) disease who underwent definitive concurrent chemoradiation. Factors evaluated included lymph node size, low-neck lymphadenopathy, retropharyngeal lymphadenopathy, overt radiographic extracapsular extension, and matted lymphadenopathy. RESULTS On multivariate analysis adjusted for age, smoking history, and chemotherapy regimen, low-neck lymphadenopathy (hazard ratio (HR) = 6.55; P < .001) and retropharyngeal lymphadenopathy (HR = 3.36; P = .009) predicted for inferior progression-free survival (PFS). low-neck lymphadenopathy (HR = 6.38; P = .001) and retropharyngeal lymphadenopathy (HR = 3.32; P = .02) also predicted for inferior overall survival (OS). All other radiographic characteristics showed no prognostic impact for PFS or OS. CONCLUSIONS This analysis suggests that caution should be advised against de-intensification efforts among patients with stage I node-positive p16-positive OPSCC with low-neck lymphadenopathy or retropharyngeal lymphadenopathy.
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Affiliation(s)
- Onita Bhattasali
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, California
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Los Angeles, California
| | - Andrew J Schumacher
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, California
| | - Shawn Iganej
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, California
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Howard J, Dwivedi RC, Masterson L, Kothari P, Quon H, Holsinger FC. De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Cochrane Database Syst Rev 2018; 12:CD012939. [PMID: 30550641 PMCID: PMC6517188 DOI: 10.1002/14651858.cd012939.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell cancer (OPSCC) are diagnosed every year worldwide and this is rising. Much of the increase has been attributed to human papillomavirus (HPV). HPV-positive OPSCC patients are often younger and have significantly improved survival relative to HPV-negative patients. Traditional management of OPSCC has been with radiotherapy with or without chemotherapy, as this was shown to have similar survival to open surgery but with significantly lower morbidity. Techniques have evolved, however, with the development of computerised planning and intensity-modulated radiotherapy, and of minimally invasive surgical techniques. Acute and late toxicities associated with chemoradiotherapy are a significant burden for OPSCC patients and with an ever-younger cohort, any strategies that could decrease treatment-associated morbidity should be investigated. OBJECTIVES To assess the effects of de-intensified adjuvant (chemo)radiotherapy in comparison to standard adjuvant (chemo)radiotherapy in patients treated with minimally invasive transoral surgery (transoral robotic surgery or transoral laser microsurgery) for resectable HPV-positive oropharyngeal squamous cell carcinoma. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 26 April 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) in patients with carcinoma of the oropharynx (as defined by the World Health Organization classification C09, C10). Cancers included were primary HPV-positive squamous cell tumours originating from the oropharyngeal mucosa. Tumours were classified as T1-4a with or without nodal spread and with no evidence of distant metastatic spread. The intervention was minimally invasive transoral surgery followed by de-intensified adjuvant therapy (either omission of chemotherapy or reduced-dose radiotherapy). The comparator was minimally invasive transoral surgery followed by standard concurrent chemoradiotherapy or standard-dose radiotherapy. The treatments received were of curative intent and patients had not undergone any prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related survival was to be studied where possible) and disease-free survival, measured at one, two, three and five years. Our secondary outcomes included assessment of swallowing ability and voice, measured at one, six, 12 and 24 months. We planned to use GRADE to assess the quality of evidence for each outcome. MAIN RESULTS We did not identify any completed RCTs that met our inclusion criteria. However, three eligible studies are in progress:ADEPT is a phase III trial comparing postoperative radiotherapy with or without cisplatin in HPV-positive T1-4a OPSCC patients. Included patients must have received minimally invasive surgery and demonstrated extra-capsular spread from disease in the neck.ECOG-E3311 is a phase II trial of treatment for HPV-positive locally advanced OPSCC (stages III-IVa + IVb without distant metastasis). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy.PATHOS is a phase III trial of treatment for HPV-positive OPSCC (T1-3, N0-2b). Patients are stratified after minimally invasive surgery. Medium-risk patients are randomised to either standard or reduced-dose radiotherapy. High-risk patients are randomised to radiotherapy with or without concurrent cisplatin. AUTHORS' CONCLUSIONS This review highlights the current lack of high-quality randomised controlled trials studying treatment de-escalation after minimally invasive surgery in patients with HPV-positive OPSCC. However, trials that will meet the inclusion criteria for this review are in progress with results expected between 2021 and 2023.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Harry Quon
- Sidney Kimmel Comprehensive Cancer CenterDepartment of Radiation Oncology and Molecular Radiation Sciences401 North Broadway‐Suite 1440BaltimoreUSA
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Kirtane K, Rodriguez CP. Postoperative Combined Modality Treatment in High Risk Resected Locally Advanced Squamous Cell Carcinomas of the Head and Neck (HNSCC). Front Oncol 2018; 8:588. [PMID: 30564559 PMCID: PMC6288294 DOI: 10.3389/fonc.2018.00588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who undergo upfront curative intent resection for locally advanced squamous cell carcinomas and who have adverse pathologic features benefit from adjuvant therapy. Concurrent cisplatin based chemoradiation is an established standard of care endorsed by national guidelines. Controversy now exists on the applicability of this strategy to the good risk human papilloma virus (HPV) related oropharynx cancer (OPC) patient. Ongoing clinical studies are exploring therapeutic de-escalation in the postoperative setting for this distinct patient population. The introduction of immune checkpoint inhibitors to the therapeutic armamentarium for recurrent/metastatic head and neck cancer patients has led to clinical investigation of incorporation of PD-1 inhibition in the postoperative setting.
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Affiliation(s)
| | - Cristina P Rodriguez
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
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Impact of Smoking on Outcomes of HPV-related Oropharyngeal Cancer Treated with Primary Radiation or Surgery. Int J Radiat Oncol Biol Phys 2018; 103:1125-1131. [PMID: 30513378 DOI: 10.1016/j.ijrobp.2018.11.046] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Tobacco exposure is known to affect the biological behavior of human papilloma virus (HPV)-positive oropharyngeal carcinoma (OPC) with intermediate outcomes relative to tumors that are HPV associated with no smoking exposure and smoking-related HPV-negative tumors. We aim to evaluate the impact of smoking on the outcomes of patients with HPV-associated locally advanced OPC when stratified by treatment modality. METHODS AND MATERIALS A retrospective chart review was undertaken for 352 patients with known p16-overexpressing locally advanced OPC who were managed with curative-intent therapy from 2006 to 2015. The impact of smoking status on overall survival (OS) and recurrence-free survival were compared using the Kaplan-Meier method. RESULTS Of the 352 patients, 67.6% (n = 238) were managed with primary chemoradiation therapy (CRT) and 32.4% (n = 114) with primary surgery ± adjuvant therapy. The median smoking pack-year was 15. Twenty-seven percent of patients were active smokers at the time of presentation, with 40.3% identifying as former smokers and 32.7% having never smoked. Median follow-up for surviving patients was 4.2 years. Current smokers had a significantly worse relapse-free survival and OS compared with never and former smokers (P = .03 and P = .0001, respectively), with outcomes significantly worsening with increasing smoking exposure. The 5-year OS for more than 10, 20, and 30 pack-year smoking history was 73.2%, 64.7%, and 59.1%, respectively. Current smokers managed with CRT had a 5-year OS of 64.2% compared with former and never smokers (93.1% and 78.2%, respectively). For current smokers managed primarily by surgery the 5-year OS was 57.6% compared with former and never smokers (69.6% and 73.5%, respectively). CONCLUSIONS Current smokers and those with higher smoking exposure had poorer outcomes irrespective of their primary modality of treatment. Although not the specific focus of the study, definitive CRT appeared to at least be equivalent to surgery with respect to disease outcomes for patients with HPV-associated oropharyngeal cancer, regardless of smoking status.
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Bullock MJ, Beitler JJ, Carlson DL, Fonseca I, Hunt JL, Katabi N, Sloan P, Taylor SM, Williams MD, Thompson LDR. Data Set for the Reporting of Nodal Excisions and Neck Dissection Specimens for Head and Neck Tumors: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting. Arch Pathol Lab Med 2018; 143:452-462. [DOI: 10.5858/arpa.2018-0421-sa] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Standardized, synoptic pathologic reporting for tumors greatly improves communication among clinicians, patients, and researchers, supporting prognostication and comparison about patient outcomes across institutions and countries. The International Collaboration on Cancer Reporting is a nonprofit organization whose mission is to develop evidence-based, universally available surgical pathology reporting data sets. Within the head and neck region, lymph node excisions and neck dissections are frequently performed as part of the management of head and neck cancers arising from the mucosal sites (sinonasal tract, nasopharynx, oropharynx, hypopharynx, oral cavity, and larynx) along with bone tumors, skin cancers, melanomas, and other tumor categories. The type of specimen, exact location (lymph node level), laterality, and orientation (by suture or diagram) are essential to accurate classification. There are significant staging differences for each anatomic site within the head and neck when lymph node sampling is considered, most importantly related to human papillomavirus–associated oropharyngeal carcinomas and mucosal melanomas. Number, size, and site of affected lymph nodes, including guidelines on determining the size of tumor deposits and the presence of extranodal extension and soft tissue metastasis, are presented in the context of prognostication. This review elaborates on each of the elements included in the data set for Nodal Excisions and Neck Dissection Specimens for Head & Neck Tumours.
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Affiliation(s)
- Martin J. Bullock
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Jonathan J. Beitler
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Diane L. Carlson
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Isabel Fonseca
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Jennifer L. Hunt
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Nora Katabi
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Philip Sloan
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - S. Mark Taylor
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Michelle D. Williams
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
| | - Lester D. R. Thompson
- From the Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada (Dr Bullock); the Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (Dr Beitler); the Pathology and Laboratory Medicine Institute, Cleveland Clinic, Weston, Florida (Dr Carlson); the Instituto de Anatomia Patológica, Faculd
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Radiologic-Pathologic Correlation of Extranodal Extension in Patients With Squamous Cell Carcinoma of the Oral Cavity: Implications for Future Editions of the TNM Classification. Int J Radiat Oncol Biol Phys 2018; 102:698-708. [DOI: 10.1016/j.ijrobp.2018.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 11/24/2022]
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The 8th edition AJCC/UICC TNM staging for p16-positive oropharyngeal carcinoma: is there space for improvement? Eur Arch Otorhinolaryngol 2018; 275:3087-3091. [DOI: 10.1007/s00405-018-5156-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023]
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66
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Huang SH, Hahn E, Tsang RK, Chen ZJ, O'Sullivan B. The interplay of IMRT and transoral surgery in HPV-mediated oropharyngeal cancer: Getting the balance right. Oral Oncol 2018; 86:171-180. [PMID: 30409297 DOI: 10.1016/j.oraloncology.2018.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/16/2018] [Indexed: 12/29/2022]
Abstract
Transoral surgery (TOS) and IMRT represent two primary local ablative treatment modalities for oropharyngeal cancer (OPC). The choice of one over the other represents an interplay between the chance of cure vs risk of late sequelae. HPV-mediated (HPV+) OPC patients generally have excellent outcomes, especially in TNM-8 stage I disease. Controversies exist over which treatment has a more favorable toxicity profile and equal efficacy in the management of this population. Non-randomized retrospective data show comparable oncological and functional outcomes between TOS-based vs IMRT-based treatment for this disease. Several de-intensification concepts have been explored in this subset in both primary surgery-based vs primary radiotherapy-based trials. However, no robust mature trial data are available to convincingly guide treatment selection. TOS is often presented as one of the de-intensification options although the majority of series also describe the use of adjuvant treatments which inevitably result in non-negligible toxicities. Patient selection and surgeons' training are paramount. Understanding tumor biology and the prognostic value of traditional 'adverse' features will further guide trial design for refinement of risk tailored approach. In conclusion, comparative data suggests TOS and IMRT are both effective treatment for TNM-8 stage I HPV+ OPC with similar oncological and functional outcomes. TOS as a single modality has potential advantages in mitigating radiation included toxicities. TOS should be avoided in the presence of clinically overt extranodal extension or when negative margins are unlikely to be achieved. TOS is also less ideal for cases with radiological features predicting a high risk of distant metastasis.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Raymond K Tsang
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Zhi-Jian Chen
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
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Sinha P, Haughey BH, Kallogjeri D, Jackson RS. Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors. Laryngoscope 2018; 129:1141-1149. [DOI: 10.1002/lary.27472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Head and Neck SurgeryFlorida Hospital Celebration Health, Celebration Florida U.S.A
- Department of SurgeryUniversity of Auckland Faculty of Medicine and Health Sciences Auckland New Zealand
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
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Rock K, O’Sullivan B, Chen ZJ, Xu ZY, Li JS, Huang SH. Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0214-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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69
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Magnitude of benefit for adjuvant radiotherapy following minimally invasive surgery in intermediate to high risk HPV-positive oropharyngeal squamous cell carcinoma. Oral Oncol 2018; 82:181-186. [DOI: 10.1016/j.oraloncology.2018.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
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Siddiq S, Cartlidge D, Stephen S, Sathasivam HP, Fox H, O'Hara J, Meikle D, Iqbal MS, Kelly CG, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with high risk human papillomavirus related squamous cell cancer. Eur Arch Otorhinolaryngol 2018; 275:1853-1860. [PMID: 29754260 DOI: 10.1007/s00405-018-4968-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy. METHODS 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS). RESULTS Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4). CONCLUSIONS This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC.
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Affiliation(s)
- Somiah Siddiq
- Head and Neck unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - David Cartlidge
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Sarah Stephen
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Hans P Sathasivam
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Hannah Fox
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - James O'Hara
- Otolaryngology, Head and Neck Surgery, Newcastle upon Tyne Hospitals and Newcastle University, Newcastle upon Tyne, NE7 7DN, UK
| | - David Meikle
- Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Charles G Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, NE7 7DN, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, UK.
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71
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Hararah MK, Stokes WA, Jones BL, Oweida A, Ding D, McDermott J, Goddard J, Karam SD. Nomogram for preoperative prediction of nodal extracapsular extension or positive surgical margins in oropharyngeal squamous cell carcinoma. Oral Oncol 2018; 83:73-80. [PMID: 30098782 DOI: 10.1016/j.oraloncology.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extracapsular extension (ECE) in regional lymph nodes and positive surgical margins (PSM) are considered high-risk adverse pathologic features in patients with oropharyngeal squamous cell carcinoma (OPSCC) that each constitute an indication for postoperative adjuvant chemoradiation. We identify pre-operative clinical factors that can predict post-operative ECE and/or PSM and create a nomogram to help clinical decision making. METHODS Adult patients with non-metastatic OPSCC with initial surgical treatment and confirmed HPV status diagnosed between 2010 and 2014 were selected from the National Cancer Database. Clinical staging was modified to American Joint Committee on Cancer 8th edition parameters. Logistic regression was used for multivariate analysis to identify predictors of pathologic ECE and/or PSM. RESULTS 5065 patients were included. 47.5% of the 3336 HPV-positive (HPV+) patients had ECE/PSM. 40.4% of the 1729 HPV-negative (HPV-) patients with had ECE/PSM. A model was built that included age, clinical ECE, tumor grade, and clinical T and N staging for HPV+ patients. Increasing N-classification was highly predictive of pathologic ECE and/or PSM (N1 OR = 3.6, N2 OR = 7.0, N3 OR = 11.2, p < 0.01). Clinical ECE (OR = 4.1, p < 0.01), tumor grade (ORs 2.2-4.4 with p < 0.05), and increasing clinical T-classification (ORs 1.2-1.8, p < 0.05) were also associated with ECE and/or PSM. A similar model was built for HPV- with similar predictive capability. Two internally validated nomograms were designed that demonstrated good discrimination (HPV+ AUC = 0.66, 95% CI: 0.64-0.68, and HPV- AUC = 0.70, 95% CI: 0.67-0.72) and good calibration (goodness-of-fit statistic of HPV+ 6.32, p = 0.61 and HPV- 11.66, p = 0.17). CONCLUSIONS These are the first nomograms designed to help predict ECE or PSM for both HPV+ and HPV- OPSCC. The nomograms can facilitate shared decision-making between clinicians and patients as they consider upfront treatment selection for OPSCC.
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Affiliation(s)
- Mohammad K Hararah
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - William A Stokes
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Bernard L Jones
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ayman Oweida
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ding Ding
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica McDermott
- Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Julie Goddard
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sana D Karam
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
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Shin JY, Yoon JK, Shin AK, Diaz AZ. Locoregionally advanced oral cavity cancer: A propensity-score matched analysis on overall survival with emphasis on the impact of adjuvant radiotherapy. Head Neck 2018; 40:1934-1946. [DOI: 10.1002/hed.25185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 01/02/2018] [Accepted: 02/20/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jacob Y. Shin
- Department of Radiation Oncology; Rush University Medical Center; Chicago Illinois
| | - Ja Kyoung Yoon
- Department of Radiation Oncology; Rush University Medical Center; Chicago Illinois
| | - Aaron K. Shin
- School of Dentistry; University of Michigan; Ann Arbor Michigan
| | - Aidnag Z. Diaz
- Department of Radiation Oncology; Rush University Medical Center; Chicago Illinois
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73
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Upfront surgery versus definitive chemoradiotherapy in patients with human Papillomavirus-associated oropharyngeal squamous cell cancer. Oral Oncol 2018; 79:64-70. [DOI: 10.1016/j.oraloncology.2018.02.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 11/22/2022]
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74
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Huang SH, O'Sullivan B. Overview of the 8th Edition TNM Classification for Head and Neck Cancer. Curr Treat Options Oncol 2018; 18:40. [PMID: 28555375 DOI: 10.1007/s11864-017-0484-y] [Citation(s) in RCA: 389] [Impact Index Per Article: 64.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT The main purpose of the TNM system is to provide an anatomic-based classification to adequately depict cancer prognosis. Accurate cancer staging is important for treatment selection and outcome prediction, research design, and cancer control activities. To maintain clinical relevance, periodical updates to TNM are necessary. The recently published 8th edition TNM classification institutes the following changes to the staging of head and neck (excluding thyroid cancer): new stage classifications [HPV-related oropharyngeal cancer (HPV+ OPC) and soft tissue sarcoma of the head and neck (HN-STS)] and modification of T and N categories [T and N categories for nasopharyngeal cancer (NPC), T categories for oral cavity squamous cell carcinomas (OSCC), N categories for non-viral related head and neck cancer and unknown primary (CUP), and T categories for head and neck cutaneous carcinoma]. These changes reflect better understanding tumor biology and clinical behavior (e.g., HPV+ OPC and HN-STS), improved outcomes associated with technical advances in diagnosis and treatment (e.g., NPC), evolving knowledge about additional prognostic factors and risk stratification from research and observation (e.g., inclusion of depth of invasion variable for OSCC, inclusion of extranodal extension variable for all non-viral head and neck cancer, and reintroduction of size criteria for non-Merkel cell cutaneous carcinoma of the head and neck). This review summarizes the changes and potential advantages and limitations/caveats associated with them. Further evidence is needed to evaluate whether these changes would result in improvement in TNM stage performance to better serve the needs for clinical care, research, and cancer control.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology, The Princess Margaret Cancer Centre, University of Toronto, RM 7-323, 700 University Ave, Toronto, Ontario, M5G 1Z5, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, The Princess Margaret Cancer Centre, University of Toronto, RM 7-323, 700 University Ave, Toronto, Ontario, M5G 1Z5, Canada.
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Wittekindt C, Wagner S, Sharma SJ, Würdemann N, Knuth J, Reder H, Klußmann JP. [HPV - A different view on Head and Neck Cancer]. Laryngorhinootologie 2018; 97:S48-S113. [PMID: 29905354 PMCID: PMC6540966 DOI: 10.1055/s-0043-121596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancer is the sixth most common cancer with over 500000 annually reported incident cases worldwide. Besides major risk factors tobacco and alcohol, oropharyngeal squamous cell carcinomas (OSCC) show increased association with human papillomavirus (HPV). HPV-associated and HPV-negative OSCC are 2 different entities regarding biological characteristics, therapeutic response, and patient prognosis. In HPV OSCC, viral oncoprotein activity, as well as genetic (mutations and chromosomal aberrations) and epigenetic alterations plays a key role during carcinogenesis. Based on improved treatment response, the introduction of therapy de-intensification and targeted therapy is discussed for patients with HPV OSCC. A promising targeted therapy concept is immunotherapy. The use of checkpoint inhibitors (e.g. anti-PD1) is currently investigated. By means of liquid biopsies, biomarkers such as viral DNA or tumor mutations in the will soon be available for disease monitoring, as well as detection of treatment failure. By now, primary prophylaxis of HPV OSCC can be achieved by vaccination of girls and boys.
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Affiliation(s)
- Claus Wittekindt
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Steffen Wagner
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Shachi Jenny Sharma
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Nora Würdemann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jennifer Knuth
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Henrike Reder
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jens Peter Klußmann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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Role of PET/MRI in oral cavity and oropharyngeal cancers based on the 8th edition of the AJCC cancer staging system: a pictorial essay. Ann Nucl Med 2018; 32:239-249. [DOI: 10.1007/s12149-018-1244-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
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Lu S, Concha-Benavente F, Shayan G, Srivastava RM, Gibson SP, Wang L, Gooding WE, Ferris RL. STING activation enhances cetuximab-mediated NK cell activation and DC maturation and correlates with HPV + status in head and neck cancer. Oral Oncol 2018; 78:186-193. [PMID: 29496049 PMCID: PMC5877820 DOI: 10.1016/j.oraloncology.2018.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 12/19/2022]
Abstract
Objectives The intracellular DNA sensor stimulator of interferon genes (STING) has recently been shown to play a vital role in anti-viral and anti-tumor immune responses stimulating cytokine production. While human papillomavirus (HPV) is a causative agent for a subset of head and neck squamous cell carcinoma (HNSCC) with unique etiology and clinical outcome, how the STING pathway is regulated in a virus-induced tumor microenvironment is not well understood. Since STING inactivation likely reflects immunoescape via innate immunity, we hypothesized that its restoration would improve efficacy of the immune modulatory monoclonal antibody (mAb), cetuximab. Materials and methods We correlated STING protein expression with clinical parameters by immunohistochemistry (n = 106) and its mRNA expression from The Cancer Genome Atlas (TCGA) in HNSCC tissue specimens. STING protein expression was tested for association with cancer-specific survival (CSS). We further examined the impact of STING activation on cetuximab-mediated immunity using an in vitro NK:DC:tumor cells co-culture system. Results In this study, we found that expression of STING both at the protein and mRNA level was higher in HPV positive (HPV+) specimens but unrelated to TNM stage or cancer-specific survival. Our in vitro studies verified that STING activation enhanced cetuximab mediated NK cell activation and DC maturation. Conclusion Our findings suggest a novel role of STING in HPV-related carcinogenesis, in which activation of the STING signaling pathway may facilitate anti-tumor response in HNSCC patients, particularly in combination with therapeutic monoclonal antibodies (mAbs) such as cetuximab, an epidermal growth factor receptor (EGFR) inhibitor.
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Affiliation(s)
- Shanhong Lu
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | | | | | - Sandra P Gibson
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lin Wang
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William E Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert L Ferris
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA; Cancer Immunology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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Huang SH, O'Sullivan B, Waldron J. The Current State of Biological and Clinical Implications of Human Papillomavirus-Related Oropharyngeal Cancer. Semin Radiat Oncol 2018; 28:17-26. [DOI: 10.1016/j.semradonc.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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79
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Troussier I, Klausner G, Morinière S, Blais E, Jean-Christophe Faivre, Champion A, Geoffrois L, Pflumio C, Babin E, Maingon P, Thariat J. [Advances in the management of cervical lymphadenopathies of unknown primary: advances in diagnostic imaging and surgical modalities and new international staging system]. Bull Cancer 2017; 105:181-192. [PMID: 29275831 DOI: 10.1016/j.bulcan.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Cervical lymphadenopathies of unknown primary represent 3 % of head and neck cancers. Their diagnostic work up has largely changed in recent years. This review provides an update on diagnostic developments and their potential therapeutic impact. MATERIALS AND METHODS This is a systematic review of the literature. RESULTS In recent years, changes in epidemiology-based prognostic factors such as human papilloma virus (HPV) cancers, advances in imaging and minimally invasive surgery have been integrated in the management of cervical lymphadenopathies of unknown primary. In particular, systematic use of PET scanner and increasing practice of robotic or laser surgery have contributed to increasing detection rate of primary cancers. These allow more adapted and personalized treatments. The impact of changes in the eighth TNM staging system is discussed. CONCLUSION The management of cervical lymphadenopathies of unknown primary cancer has changed significantly in the last 10 years. On the other hand, practice changes will have to be assessed.
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Affiliation(s)
- Idriss Troussier
- CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Klausner
- Institut Gustave-Roussy, radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Sylvain Morinière
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Eivind Blais
- Centre Bergonié, radiothérapie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Jean-Christophe Faivre
- Institut de cancérologie de Lorraine, oncologie médicale, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Ambroise Champion
- Hôpitaux universitaires Genève, radiothérapie, rue Gabrielle-Perret-Gentil, 4, 1205 Genève, Suisse
| | - Lionnel Geoffrois
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Carole Pflumio
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Emmanuel Babin
- CHRU de Caen, carcinologie cervicofaciale, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - Philippe Maingon
- CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Thariat
- ARCHADE centre François-Baclesse, radiothérapie, 3, avenue du Général-Harris, 14000 Caen, France.
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Jackson RS, Sinha P, Zenga J, Kallogjeri D, Suko J, Martin E, Moore EJ, Haughey BH. Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy. Ann Surg Oncol 2017; 24:3494-3501. [PMID: 28808988 PMCID: PMC9012985 DOI: 10.1245/s10434-017-6041-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 12/04/2023]
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.
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Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA.
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Jasmina Suko
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA
- Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA
| | - Eliot Martin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bruce H Haughey
- Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health and Florida Hospital Cancer Institute, Celebration, FL, USA
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81
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Ajmani GS, Nocon CC, Wang CH, Bhayani MK. Assessment of adjuvant therapy in resected head and neck cancer with high-risk features. Oral Oncol 2017; 74:15-20. [DOI: 10.1016/j.oraloncology.2017.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 01/21/2023]
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Extracapsular extension is associated with worse distant control and progression-free survival in patients with lymph node-positive human papillomavirus-related oropharyngeal carcinoma. Oral Oncol 2017; 74:56-61. [DOI: 10.1016/j.oraloncology.2017.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/24/2017] [Accepted: 09/15/2017] [Indexed: 01/03/2023]
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Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, Gross N, Andersen PE, Clayburgh D. Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2017; 144:18-27. [PMID: 29075740 DOI: 10.1001/jamaoto.2017.1790] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. Objective To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). Design, Setting, and Participants This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. Main Outcomes and Measures Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. Results Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). Conclusions and Relevance Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.
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Affiliation(s)
- Virginie Achim
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Rachel K Bolognone
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Andrew D Palmer
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Donna J Graville
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Tyler J Light
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Ryan Li
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Neil Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Peter E Andersen
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Daniel Clayburgh
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
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84
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Badhey AK, Olson A, Kadakia S, Russo J, Ting P, Khalid M, Yao M, Teng MS, Genden EM, Miles BA, Chai RL. Application of the Eighth Edition American Joint Committee on Cancer Staging System for HPV-Related Oropharyngeal Cancer Treated With Transoral Robotic Surgery. Laryngoscope 2017; 128:1133-1139. [DOI: 10.1002/lary.26948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 09/05/2017] [Indexed: 01/02/2023]
Affiliation(s)
| | - Ashley Olson
- Department of Population Health Science and Policy
| | | | - Jack Russo
- Department of Head and Neck Surgery; Kaiser Sacramento Medical Center; Sacramento California U.S.A
| | - Peter Ting
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Mian Khalid
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Mike Yao
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Marita S. Teng
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Eric M. Genden
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Brett A. Miles
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Raymond L. Chai
- Department of Otolaryngology; Icahn School of Medicine at Mount Sinai; New York New York
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85
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Turner MT, Byrd JK, Ferris RL. Current Role of Surgery in the Management of Oropharyngeal Cancer. J Oncol Pract 2017; 12:1176-1183. [PMID: 27858544 DOI: 10.1200/jop.2016.015263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d'Oncologie Radiothérapie Tête et Cou trial. Since that time, human papillomavirus-associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus-positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.
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Affiliation(s)
- Meghan T Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - J Kenneth Byrd
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - Robert L Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
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86
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Kelly HR, Curtin HD. Chapter 2 Squamous Cell Carcinoma of the Head and Neck—Imaging Evaluation of Regional Lymph Nodes and Implications for Management. Semin Ultrasound CT MR 2017; 38:466-478. [DOI: 10.1053/j.sult.2017.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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87
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Kansy BA, Concha-Benavente F, Srivastava RM, Jie HB, Shayan G, Lei Y, Moskovitz J, Moy J, Li J, Brandau S, Lang S, Schmitt NC, Freeman GJ, Gooding WE, Clump DA, Ferris RL. PD-1 Status in CD8 + T Cells Associates with Survival and Anti-PD-1 Therapeutic Outcomes in Head and Neck Cancer. Cancer Res 2017; 77:6353-6364. [PMID: 28904066 DOI: 10.1158/0008-5472.can-16-3167] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/10/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022]
Abstract
Improved understanding of expression of immune checkpoint receptors (ICR) on tumor-infiltrating lymphocytes (TIL) may facilitate more effective immunotherapy in head and neck cancer (HNC) patients. A higher frequency of PD-1+ TIL has been reported in human papillomavirus (HPV)+ HNC patients, despite the role of PD-1 in T-cell exhaustion. This discordance led us to hypothesize that the extent of PD-1 expression more accurately defines T-cell function and prognostic impact, because PD-1high T cells may be more exhausted than PD-1low T cells and may influence clinical outcome and response to anti-PD-1 immunotherapy. In this study, PD-1 expression was indeed upregulated on HNC patient TIL, and the frequency of these PD-1+ TIL was higher in HPV+ patients (P = 0.006), who nonetheless experienced significantly better clinical outcome. However, PD-1high CD8+ TILs were more frequent in HPV- patients and represented a more dysfunctional subset with compromised IFN-γ secretion. Moreover, HNC patients with higher frequencies of PD-1high CD8+ TIL showed significantly worse disease-free survival and higher hazard ratio for recurrence (P < 0.001), while higher fractions of PD-1low T cells associated with HPV positivity and better outcome. In a murine HPV+ HNC model, anti-PD-1 mAb therapy differentially modulated PD-1high/low populations, and tumor rejection associated with loss of dysfunctional PD-1high CD8+ T cells and a significant increase in PD-1low TIL. Thus, the extent of PD-1 expression on CD8+ TIL provides a potential biomarker for anti-PD-1-based immunotherapy. Cancer Res; 77(22); 6353-64. ©2017 AACR.
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Affiliation(s)
- Benjamin A Kansy
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Otorhinolaryngology, University Hospital Essen, Germany
| | | | | | - Hyun-Bae Jie
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Yu Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jessica Moskovitz
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer Moy
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jing Li
- School of Medicine, Tsinghua University, Beijing, China
| | - Sven Brandau
- Department of Otorhinolaryngology, University Hospital Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, University Hospital Essen, Germany
| | - Nicole C Schmitt
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, and National Institute on Deafness and Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William E Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania. .,Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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88
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Zhan KY, Eskander A, Kang SY, Old MO, Ozer E, Agrawal AA, Carrau RL, Rocco JW, Teknos TN. Appraisal of the AJCC 8th edition pathologic staging modifications for HPV-positive oropharyngeal cancer, a study of the National Cancer Data Base. Oral Oncol 2017; 73:152-159. [PMID: 28939068 DOI: 10.1016/j.oraloncology.2017.08.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The American Joint Commission on Cancer (AJCC) recently created new staging for human papillomavirus associated oropharyngeal cancer (HPV+ OPSCC) for its 8th edition. These proposals have not yet been validated in a national registry. METHODS Review of National Cancer Database (NCDB) for surgically-treated HPV+ OPSCC for years 2010-2014 to validate the new staging system using the Kaplan Meier method to explore survival outcomes. RESULTS 3745 cases were analyzed. Median follow-up was 31.3months. Most patients were Caucasian males with tonsillar cancer. Distribution of stage I disease increased from 3.7% to 80.2% in AJCC 8th. pN1 disease shifted from 17.3% to 75.9%. Treatment and distribution of T-stage varied by pathologic nodal (pN) staging. Extranodal extension (ENE) was positive in 41% cases. Four-year overall survival (OS) for AJCC 8th stages I (92%), II (81%), and stage III (62%) showed excellent hazard discrimination (all pairwise p<0.001). Only 4-year OS by pN staging showed significantly different curves when comparing pN2 (79%) with others (pN0 88%; pN1 91%, p=0.01 and <0.001 respectively). Presence of ENE confers a negative effect on overall survival (92% ENE- vs. 85% ENE+, p<0.001). CONCLUSION The NCDB shows improved hazard discrimination and outcome prediction in the AJCC 8th edition staging for HPV+ OPSCC. While overall staging had excellent hazard discrimination, this accounted for poorer discrimination between pN0 and pN1. The majority of patients are reclassified as overall stage I. Presence of extranodal extension demonstrated a statistically significant but modest negative effect on overall survival. CONDENSED ABSTRACT (2 SENTENCES): Using NCDB data for validation, the AJCC 8th ed. pathologic staging system offers much improved hazard discrimination and prognostication in HPV oropharyngeal cancer, with the majority of cases reclassified as pStage I. Of note, only pN2 offered hazard discrimination within nodal staging and presence of pathologic extranodal extension has a modest negative effect on survival.
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Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Stephen Y Kang
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Enver Ozer
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Amit A Agrawal
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA
| | - Theodoros N Teknos
- Department of Otolaryngology - Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA.
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Abstract
OPINION STATEMENT Given the potential for long-term toxicities from concurrent chemoradiation, there is great interest in surgery as a primary treatment modality for head and neck cancers, particularly in the younger HPV-positive oropharyngeal cancer patient. Transoral robotic surgery (TORS) has proven to be an effective technique to safely treat oropharyngeal and select supraglottic tumors surgically. Sound, traditional surgical principles are employed using improved endoscopic visualization and precise instrumentation to perform oncologic surgery without the morbidity of transmandibular or transcervical approaches. Although level 1 evidence prospective clinical trials are currently underway for TORS, the literature supports its safety and efficacy based on numerous studies. Currently, prospective randomized trials are underway to provide better evidence for or against TORS in oropharyngeal cancer. Patient selection based on comorbidities, anatomy, and available pathological data is critical in choosing patients for TORS.
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90
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Cohen ER, Reis IM, Gomez C, Pereira L, Freiser ME, Hoosien G, Franzmann EJ. Immunohistochemistry Analysis of CD44, EGFR, and p16 in Oral Cavity and Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:239-251. [PMID: 28397583 DOI: 10.1177/0194599817700371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/28/2017] [Indexed: 12/26/2022]
Abstract
Objectives We analyze the relationship between CD44, epidermal growth factor receptor (EGFR), and p16 expression in oral cavity and oropharyngeal cancers in a diverse population. We also describe whether particular patterns of staining are associated with progression-free survival and overall survival. Study Design Prospective study, single-blind to pathologist and laboratory technologist. Setting Hospital based. Subjects and Methods Immunohistochemistry, comprising gross staining and cellular expression, was performed and interpreted in a blinded fashion on 24 lip/oral cavity and 40 oropharyngeal cancer specimens collected between 2007 and 2012 from participants of a larger study. Information on overall survival and progression-free survival was obtained from medical records. Results Nineteen cases were clinically p16 positive, 16 of which were oropharyngeal. Oral cavity lesions were more likely to exhibit strong CD44 membrane staining ( P = .0002). Strong CD44 membrane and strong EGFR membrane and/or cytoplasmic staining were more common in p16-negative cancers ( P = .006). Peripheral/mixed gross p16 staining pattern was associated with worse survival than the universal staining on univariate and multivariate analyses ( P = .006, P = .030). This held true when combining gross and cellular localization for p16. For CD44, universal gross staining demonstrated poorer overall survival compared with the peripheral/mixed group ( P = .039). CD44 peripheral/mixed group alone and when combined with universal p16 demonstrated the best survival on multivariate analysis ( P = .010). Conclusion In a diverse population, systematic analysis applying p16, CD44, and EGFR gross staining and cellular localization on immunohistochemistry demonstrates distinct patterns that may have prognostic potential exceeding current methods. Larger studies are warranted to investigate these findings further.
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Affiliation(s)
- Erin R Cohen
- 1 Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Isildinha M Reis
- 2 Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- 3 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carmen Gomez
- 4 Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lutecia Pereira
- 2 Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monika E Freiser
- 1 Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gia Hoosien
- 1 Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth J Franzmann
- 1 Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
- 2 Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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91
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Gilbert MR, Sharma A, Schmitt NC, Johnson JT, Ferris RL, Duvvuri U, Kim S. A 20-Year Review of 75 Cases of Salivary Duct Carcinoma. JAMA Otolaryngol Head Neck Surg 2017; 142:489-95. [PMID: 26939990 DOI: 10.1001/jamaoto.2015.3930] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Salivary duct carcinoma is a rare, aggressive malignancy of the salivary glands. Owing to its rare nature, clinical data are limited, and only a few clinical studies comprise more than 50 patients. OBJECTIVE To review the University of Pittsburgh Medical Center's experience with salivary duct carcinoma over a 20-year period, focusing on demographics, presentation, treatment, and outcome. DESIGN, SETTING, AND PARTICIPANTS This investigation was a retrospective cohort study in a multihospital institution with tertiary referral. A pathology database was reviewed for all cases of histopathologically diagnosed salivary duct carcinoma from January 1, 1995, to October 20, 2014. Patients who were referrals for pathology review only and were never seen at the institution were excluded. In total, 75 study patients were identified. The electronic medical record was reviewed for details regarding demographics, presentation, treatment, and outcome, including overall survival (OS) and disease-free survival (DFS). This study was supplemented with a review of the institution's Head and Neck Oncology Database for further clinical details. MAIN OUTCOMES AND MEASURES Primary outcome measures consisted of OS and DFS. RESULTS The study sample comprised 75 participants with a mean age at diagnosis of 66.0 years (age range, 33-93 years), and 29% (n = 22) were female. Most primary tumors were from the parotid gland (83%), with the next most frequent site being the submandibular gland (12%). Overall, 41% of the cases were carcinoma ex pleomorphic adenoma. Rates of other histologic features included the following: perineural invasion (69%), extracapsular spread (58%), ERBB2 (formerly HER2) positivity (31%) (62% of those who were tested), and vascular invasion (61%). The median OS was 3.1 years, and the median DFS was 2.7 years. Univariate Kaplan-Meier survival analyses demonstrated that facial nerve sacrifice and extracapsular spread were associated with lower OS (2.38 vs 5.11 years and 2.29 vs 6.56 years, respectively) and DFS (2.4 vs 3.88 years and 1.44 vs 4.5 years, respectively). Although underpowered, multivariable analysis demonstrated significantly worse OS in patients with N2 and N3 disease (hazard ratio [HR] 8.42, 95% CI, 1.84-38.5) but did not show significantly worse DFS or OS for facial nerve sacrifice or extracapsular spread. There was no association between ERBB2 positivity and survival and no difference in survival between patients receiving radiation therapy vs radiation therapy plus chemotherapy. No patients had recurrence or distant metastasis after 5 disease-free years. CONCLUSIONS AND RELEVANCE Salivary duct carcinoma is an aggressive disease. A large number of cases in this review were carcinoma ex pleomorphic adenoma and had classic negative prognostic indicators, such as perineural invasion, vascular invasion, and extracapsular spread. ERBB2 positivity was not associated with any difference in survival. Facial nerve involvement appears to indicate worse prognosis, as does nodal stage higher than N1. Recurrence and metastasis after 5 years are rare.
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Affiliation(s)
- Mark R Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arun Sharma
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Southern Illinois University, Springfield
| | - Nicole C Schmitt
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Jonas T Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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92
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Controversies in Postoperative Irradiation of Oropharyngeal Cancer After Transoral Surgery. Surg Oncol Clin N Am 2017; 26:357-370. [DOI: 10.1016/j.soc.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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93
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Roman BR, Baxi SS, Cracchiolo JR, Blackwell TJ, Pfister DG, McBride S, Ganly I, Shah JP, Patel SG, Morris LG, Cohen MA. Variation in use of postoperative chemoradiation following surgery for T1 and T2 oropharyngeal squamous cell carcinoma; National Cancer Database. J Surg Oncol 2017; 116:351-358. [PMID: 28570758 DOI: 10.1002/jso.24674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary surgical treatment of patients with early T-classification (T1-T2) oropharyngeal squamous cell carcinoma (OPSCC) has increased. We sought to determine how often these patients receive postoperative chemoradiation (CRT). METHODS Patients with T1-T2 OPSCC in the National Cancer Database who underwent primary surgery were evaluated for receipt of postoperative CRT. Postoperative CRT use was examined among patients with high risk factors (positive margins and/or extracapsular spread [ECS]), intermediate risk factors (negative margins, no ECS, and either pT3-4 and/or N2-N3), and no apparent risk factors. RESULTS Of 4833 patients with T1-T2 OPSCC who underwent primary surgery, 43% had high risk pathologic factors, of whom only 63% received postoperative CRT. Another 31% had no apparent risk factors, of whom 16% nonetheless received postoperative CRT. On multivariable analysis, in addition to tumor and demographic factors, patients treated at community hospitals were more likely to receive postoperative CRT (O.R. 1.41 C.I. 1.18-1.87, P = 0.001). CONCLUSIONS Variation in postoperative CRT use indicates a lack of consensus and/or knowledge about its benefits and indications. Usage of postoperative CRT regardless of pathologic risk factors suggests an area where future efforts at implementation of best practices may be targeted.
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Affiliation(s)
| | - Shrujal S Baxi
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Sean McBride
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G Morris
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Memorial Sloan Kettering Cancer Center, New York, New York
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Zamora C, Lopez M, Cunningham F, Collichio F, Castillo M. Imaging Manifestations of Pseudoprogression in Metastatic Melanoma Nodes Injected with Talimogene Laherparepvec: Initial Experience. AJNR Am J Neuroradiol 2017; 38:1218-1222. [PMID: 28428211 DOI: 10.3174/ajnr.a5206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/25/2017] [Indexed: 12/22/2022]
Abstract
Talimogene laherparepvec is an oncolytic virus recently approved for targeted treatment of advanced melanoma. Because of an inflammatory reaction, treated lesions may increase in size and develop infiltrative margins that can be construed as disease progression or extracapsular spread. In this report, we describe our initial experience imaging the response of metastatic nodes injected with talimogene laherparepvec. Six of 12 nodes (50%) showed growth from baseline followed by decreased size, 5 of 12 nodes (42%) showed a downward size trend, and 1 node showed continued increase in size. Seven of 9 nodes (78%) developed infiltrative margins at a median of 79 days, and 6 of 9 (67%) nodes became necrotic at a median of 76 days after injection, all showing decreased size at final follow-up. An increase in the size of nodes injected with talimogene laherparepvec does not necessarily indicate progression. Infiltrative margins are also frequently seen and may be confused with extracapsular disease.
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Affiliation(s)
- C Zamora
- From the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
| | - M Lopez
- From the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
| | - F Cunningham
- the Division of Hematology and Oncology, Department of Medicine (F. Cunningham, F. Collichio), University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - F Collichio
- the Division of Hematology and Oncology, Department of Medicine (F. Cunningham, F. Collichio), University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - M Castillo
- From the Division of Neuroradiology, Department of Radiology (C.Z., M.L., M.C.)
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95
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Rath TJ, Narayanan S, Hughes MA, Ferris RL, Chiosea SI, Branstetter BF. Solid Lymph Nodes as an Imaging Biomarker for Risk Stratification in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2017; 38:1405-1410. [PMID: 28450437 DOI: 10.3174/ajnr.a5177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Human papillomavirus-related oropharyngeal squamous cell carcinoma is associated with cystic lymph nodes on CT and has a favorable prognosis. A subset of patients with aggressive disease experience treatment failure. Our aim was to determine whether the extent of cystic lymph node burden on staging CT can serve as an imaging biomarker to predict treatment failure in human papillomavirus-related oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS We identified patients with human papilloma virus-related oropharyngeal squamous cell carcinoma and staging neck CTs. Demographic and clinical variables were recorded. We retrospectively classified the metastatic lymph node burden on CT as cystic or solid and assessed radiologic extracapsular spread. Biopsy, subsequent imaging, or clinical follow-up was the reference standard for treatment failure. The primary end point was disease-free survival. Cox proportional hazard regression analyses of clinical, demographic, and anatomic variables for treatment failure were performed. RESULTS One hundred eighty-three patients were included with a mean follow-up of 38 months. In univariate analysis, the following variables had a statistically significant association with treatment failure: solid-versus-cystic lymph nodes, clinical T-stage, clinical N-stage, and radiologic evidence of extracapsular spread. The multivariate Cox proportional hazard model resulted in a model that included solid-versus-cystic lymph nodes, T-stage, and radiologic evidence of extracapsular spread as independent predictors of treatment failure. Patients with cystic nodal metastasis at staging had significantly better disease-free survival than patients with solid lymph nodes. CONCLUSIONS In human papilloma virus-related oropharyngeal squamous cell carcinoma, patients with solid lymph node metastases are at higher risk for treatment failure with worse disease-free survival. Solid lymph nodes may serve as an imaging biomarker to tailor individual treatment regimens.
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Affiliation(s)
- T J Rath
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.) .,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - S Narayanan
- Department of Radiology (S.N.), Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - M A Hughes
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.).,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - R L Ferris
- Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - S I Chiosea
- Pathology (S.I.C.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - B F Branstetter
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.).,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
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96
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Roden DF, Schreiber D, Givi B. Triple-modality treatment in patients with advanced stage tonsil cancer. Cancer 2017; 123:3269-3276. [DOI: 10.1002/cncr.30728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/24/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Dylan F. Roden
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York New York
- Department of Veterans Affairs; New York Harbor Healthcare; New York New York
| | - David Schreiber
- Department of Veterans Affairs; New York Harbor Healthcare; New York New York
- Department of Radiation Oncology; State University of New York Downstate Medical Center; Brooklyn New York
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York New York
- Department of Veterans Affairs; New York Harbor Healthcare; New York New York
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97
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Ebisumoto K, Okami K, Maki D, Saito K, Shimizu F, Teramura T, Kaneda S, Iida M. Avoidance of postoperative irradiation for cervical lymph node metastases of human papillomavirus-related tonsillar cancer. Laryngoscope Investig Otolaryngol 2017; 2:63-68. [PMID: 28894824 PMCID: PMC5527367 DOI: 10.1002/lio2.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Several reports have suggested that selected patients with human papillomavirus-related oropharyngeal cancer can be managed with surgery alone. We retrospectively reviewed tonsillar cancer cases to analyze treatment de-intensification after transoral resection. METHODS Eighteen patients with tonsillar cancer who had undergone transoral resection were included. The patients' characteristics, p16 status, adverse features, clinical course, overall survival, and relapse-free survival according to p16 status were retrospectively examined. RESULTS Four lesions showed positive surgical margins and one lesion showed close surgical margin; these patients were treated with postoperative irradiation. Seven p16-positive patients had multiple node metastases and two had extracapsular spread. No p16-positive patients agreed to postoperative irradiation, and recurrence within the surgical field was not observed. The five-year overall and relapse-free survival rates were 89% and 74%, respectively. The five-year relapse-free survival rates of p16-positive and p16-negative patients were 81% and 50%, respectively (p = .075). CONCLUSIONS Postoperative irradiation for cervical lymph node metastases might be avoidable in selected patients with human papillomavirus-related tonsillar cancer. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Koji Ebisumoto
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Kenji Okami
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Daisuke Maki
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Kosuke Saito
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Fukuko Shimizu
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Takanobu Teramura
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Shoji Kaneda
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
| | - Masahiro Iida
- Department of Otolaryngology‐Head and Neck SurgeryTokai UniversityKanagawaJapan
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98
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An Y, Park HS, Kelly JR, Stahl JM, Yarbrough WG, Burtness BA, Contessa JN, Decker RH, Koshy M, Husain ZA. The prognostic value of extranodal extension in human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer 2017; 123:2762-2772. [DOI: 10.1002/cncr.30598] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Yi An
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
| | - Henry S. Park
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
| | - Jacqueline R. Kelly
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
| | - John M. Stahl
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
| | - Wendell G. Yarbrough
- Division of Otolaryngology, Department of Surgery; Yale University School of Medicine; New Haven Connecticut
- Department of Pathology; Yale University School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Barbara A. Burtness
- Yale Cancer Center; New Haven Connecticut
- Department of Medical Oncology; Yale University School of Medicine; New Haven Connecticut
| | - Joseph N. Contessa
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Roy H. Decker
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Matthew Koshy
- Department of Radiation Oncology; University of Chicago School of Medicine; Chicago Illinois
| | - Zain A. Husain
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
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99
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Carlton JA, Maxwell AW, Bauer LB, McElroy SM, Layfield LJ, Ahsan H, Agarwal A. Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes. Neuroradiol J 2017. [PMID: 28627989 DOI: 10.1177/1971400917694048] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose In patients with squamous cell carcinoma of the head and neck (HNSCC), extracapsular spread (ECS) of metastases in cervical lymph nodes affects prognosis and therapy. We assessed the accuracy of intravenous contrast-enhanced computed tomography (CT) and the utility of imaging criteria for preoperative detection of ECS in metastatic cervical lymph nodes in patients with HNSCC. Materials and methods Preoperative intravenous contrast-enhanced neck CT images of 93 patients with histopathological HNSCC metastatic nodes were retrospectively assessed by two neuroradiologists for ECS status and ECS imaging criteria. Radiological assessments were compared with histopathological assessments of neck dissection specimens, and interobserver agreement of ECS status and ECS imaging criteria were measured. Results Sensitivity, specificity, positive predictive value, and accuracy for overall ECS assessment were 57%, 81%, 82% and 67% for observer 1, and 66%, 76%, 80% and 70% for observer 2, respectively. Correlating three or more ECS imaging criteria with histopathological ECS increased specificity and positive predictive value, but decreased sensitivity and accuracy. Interobserver agreement for overall ECS assessment demonstrated a kappa of 0.59. Central necrosis had the highest kappa of 0.74. Conclusion CT has moderate specificity for ECS assessment in HNSCC metastatic cervical nodes. Identifying three or more ECS imaging criteria raises specificity and positive predictive value, therefore preoperative identification of multiple criteria may be clinically useful. Interobserver agreement is moderate for overall ECS assessment, substantial for central necrosis. Other ECS CT criteria had moderate agreement at best and therefore should not be used individually as criteria for detecting ECS by CT.
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Affiliation(s)
- Joshua A Carlton
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Adam W Maxwell
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Lyndsey B Bauer
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Sara M McElroy
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Lester J Layfield
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Humera Ahsan
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
| | - Ajay Agarwal
- Departments of Radiology and Pathology, University of Missouri Columbia School of Medicine, USA
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100
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Tassone P, Crawley M, Bovenzi C, Zhan T, Keane W, Cognetti D, Luginbuhl A, Curry J. Pathologic Markers in Surgically Treated HPV-Associated Oropharyngeal Cancer: Retrospective Study, Systematic Review, and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:365-374. [PMID: 28397563 DOI: 10.1177/0003489417693014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Human papillomavirus-associated (HPV) oropharyngeal cancer is a unique clinical entity whose incidence is increasing. It is controversial whether traditional pathologic markers of aggressive head and neck cancer also apply in surgically treated HPV-associated disease. STUDY DESIGN Retrospective study, systematic review, and meta-analysis Data Sources: PubMed and Cochrane review. REVIEW METHODS PubMed and Cochrane review were searched for published articles on surgically treated HPV-associated oropharyngeal cancer. Eligible studies were included in a meta-analysis of survival using several clinicopathologic markers as predictors. Surgically treated HPV-positive oropharyngeal cancer patients at our institution were studied retrospectively and added to the meta-analysis. RESULTS Eight published reports, plus our retrospective series, were included in the meta-analysis. This showed significant impact on event-free survival for T stage, nodal number, perineural invasion, and lymphovascular invasion (all P < .05) but not for N stage extracapsular extension ( P = ns). CONCLUSIONS While many traditional clinico-pathologic markers of aggressive disease in head and neck cancer also impact survival in surgically treated HPV-associated oropharyngeal cancer, extracapsular extension may be less important.
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Affiliation(s)
- Patrick Tassone
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meghan Crawley
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cory Bovenzi
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- 2 Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William Keane
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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