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Song Y, Cheng D, Yi X, Rao Y, Qiu K, Mao M, Pang W, Li J, Zheng Y, Feng R, Song X, Huang S, Liu G, Xu W, Zhao Y, Ren J. The role of HPV status in patients with overlapping grey zone cancer in oral cavity and oropharynx. Eur Arch Otorhinolaryngol 2023; 280:1455-1465. [PMID: 36348098 DOI: 10.1007/s00405-022-07713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE We aimed to explore the clinicodemographic characteristics and prognosis of grey zone squamous cell cancer (GZSCC) located in the overlapping or ambiguous area of oral cavity and oropharynx and to identify valuable factors that would improve its differential diagnosis and prognosis. METHODS Information of GZSCC patients in the Surveillance, Epidemiology, and End Results (SEER) database were compared to patients with oral cavity (OCSCC) and oropharyngeal (OPSCC) squamous cell carcinomas with corresponding HPV status, respectively. Kaplan-Meier method with log-rank test and multivariate Cox regression analysis were applied to assess associations between clinical characteristics and overall survival (OS). A predictive model integrating age, gender, marital status, HPV status and staging variables was conducted to classify GZSCC patients into three risk groups and verified internally by tenfold cross validation. RESULTS A total of 3318 GZSCC, 10792 OPSCC and 6656 OCSCC patients were identified. HPV-positive GZSCC patients had the best 5-year OS as HPV-positive OPSCC (81% vs. 82%). However, the 5-year OS of HPV-negative/unknown GZSCC (43%/42%) were the worst among all groups, indicating that HPV status and the overlapping nature of tumors were valuable prognostic predictors in GZSCC patients. Compared with the strategy of dividing GZSCC into two groups by HPV status, the predictive model integrating more variables could additionally identify a unique high-risk GZSCC group with the lowest OS rate. CONCLUSIONS GZSCC patients had distinct clinical characteristics and prognosis compared with OPSCC and OCSCC, integrating HPV status and other clinical factors could help distinguish GZSCC and predict their prognosis.
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Affiliation(s)
- Yao Song
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xiaowei Yi
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yufang Rao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ke Qiu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Minzi Mao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Wendu Pang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Junhong Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yongbo Zheng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Renyuan Feng
- Langzhong People's Hospital, Langzhong, Sichuan, China
| | - Xiaoping Song
- Langzhong People's Hospital, Langzhong, Sichuan, China
| | - Shaohui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health, 10-511, 610 University Avenue Toronto, Toronto, ON, Canada.
| | - Yu Zhao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China. .,Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| | - Jianjun Ren
- Department of Otolaryngology Head and Neck Surgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China. .,West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China. .,Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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Kim RY, Vincent AG, Shokri T, Ducic Y. Does Bulky Adenopathy in Human Papilloma Virus-Positive Oropharyngeal Squamous Cell Carcinoma Require a Planned Post-Treatment Neck Dissection for Occult Residual Disease? J Oral Maxillofac Surg 2023; 81:248-253. [PMID: 36528082 DOI: 10.1016/j.joms.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE A planned neck dissection was traditionally considered for a large nodal disease after definitive chemoradiation, yet controversy exists for the human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV OPSCC). We aimed to measure the frequency of persistent occult neck disease in planned neck dissection for HPV OPSCC presenting with a large (≥3.0 cm) nodal burden. METHODS We designed a retrospective cohort study at a single tertiary referral institution. The study population was sampled from 2006 to 2018 and subjects with HPV OPSCC and adenopathy ≥3.0 cm. Inclusion criteria encompassed subjects who completed primary chemoradiation therapy (CRT) or primary radiation therapy (RT), and subsequently underwent a planned neck dissection. We excluded subjects who did not complete therapy or had less than 1-year follow-up. Our primary predictor variable was the size of cervical adenopathy on presentation (3.0-3.9 cm, 4.0-4.9 cm, 5.0-5.9 cm, and ≥6.0 cm). Our primary outcome of interest was the presence of disease based on the histopathology review. Other variables included the demographics, primary treatment with CRT or RT, and post-treatment clinical or radiographic evidence of disease. Chi-square testing was used to compare rates of persistent disease, with varying sizes of cervical adenopathy on presentation. The alpha level for statistical significance was set at 0.05. RESULTS A total of 86 subjects were analyzed, with forty-one females and forty-five males, ranging from 36 to 77 years (mean 54.6 years). From the total study sample, 35% showed persistent disease, and 67% of those subjects had occult disease at the time of planned neck dissection. Greater than 20% of subjects had persistent disease when the nodal burden was ≥3.0 cm at presentation. Furthermore, there was a statistically significant difference in the rates of persistent microscopic disease among subjects with nodal burden of different sizes based on chi-square testing (P = .01, χ2 = 10.66). CONCLUSIONS Our data suggest that subjects with HPV OPSCC presenting with a nodal burden ≥3.0 cm are likely to have 23% chance of persistent occult neck disease after primary CRT or RT. These findings may support the routine treatment of these subjects with a planned neck dissection after initial therapy to confirm or surgically complete disease eradication.
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Affiliation(s)
- Roderick Y Kim
- Director of Fellowship in Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, TX.
| | - Aurora G Vincent
- Deputy Chief of Surgery, Facial Plastic and Reconstructive Surgery, Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA
| | - Tom Shokri
- Assistant Professor of Surgery, Department of Facial Plastic and Reconstructive Surgery, George Washington University, Washington, DC
| | - Yadranko Ducic
- Fellowship Director, Facial Plastic Surgery, Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX
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Randomized phase-III-trial of concurrent chemoradiation for locally advanced head and neck cancer comparing dose reduced radiotherapy with paclitaxel/cisplatin to standard radiotherapy with fluorouracil/cisplatin: The PacCis-trial. Radiother Oncol 2020; 144:209-217. [PMID: 32044419 DOI: 10.1016/j.radonc.2020.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE This multicenter, phase 3 trial investigates whether the incorporation of concurrent paclitaxel and cisplatin together with a reduced total dose of radiotherapy is superior to standard fluorouracil-cisplatin based CRT. MATERIALS AND METHODS Patients with SCCHN, stage III-IVB, were randomized to receive paclitaxel/cisplatin (PacCis)-CRT (arm A; paclitaxel 20 mg/m2 on days 2, 5, 8, 11 and 25, 30, 33, 36; cisplatin 20 mg/m2, days 1-4 and 29-32; RT to a total dose of 63.6 Gy) or fluorouracil/cisplatin (CisFU)-CRT (arm B; fluorouracil 600 mg/m2; cisplatin 20 mg/m2, days 1-5 and 29-33; RT: 70.6 Gy). Endpoint was 3-year-disease free survival (3y-DFS). RESULTS A total of 221 patients were enrolled between 2010 and 2015. With a median follow-up of 3.7 years, 3y-DFS in the CisFU arm and PacCis arm was 58.2% and 48.4%, respectively (HR 0.82, 95% CI 0.56-1.21, p = 0.52). The 3y-OS amounted to 64.6% in the CisFU arm, and to 59.2% in the PacCis arm (HR 0.82, 95% CI 0.54-1.24, p = 0.43). In the subgroup of p16-positive oropharyngeal carcinomas, 3y-DFS and 3y-OS was 84.6% vs 83.9% (p = 0.653), and 92.3% vs. 83.5% (p = 0.76) in arm A and B, respectively. Grade 3-4 hematological toxicities were significantly reduced in arm A (anemia, p = 0.01; leukocytopenia, p = 0.003), whereas grade 3 infections were reduced in arm B (p = 0.01). CONCLUSION Paclitaxel/cisplatin-CRT with a reduced RT-dose is not superior to standard fluorouracil/cisplatin-CRT. Subgroup analyses indicate that a reduced radiation dose seems to be sufficient for p16+ oropharyngeal cancer or non-smokers. CLINICAL TRIAL INFORMATION NCT01126216; EudraCT Number 2005-003484-23.
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Lewis JS, Shelton J, Kuhs KL, K Smith D. p16 Immunohistochemistry in Oropharyngeal Squamous Cell Carcinoma Using the E6H4 Antibody Clone: A Technical Method Study for Optimal Dilution. Head Neck Pathol 2018; 12:440-447. [PMID: 29190003 PMCID: PMC6232210 DOI: 10.1007/s12105-017-0871-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
Routine testing for p16 immunohistochemistry (with selective HPV-specific test use) has been recommended for clinical practice in oropharyngeal squamous cell carcinoma (OPSCC). Data suggests that the E6H4 clone performs best for this purpose, yet no studies have evaluated the optimal antibody concentration for OPSCC testing. We evaluated three concentrations (undiluted, 1:5, and 1:10) of the primary antibody solution for E6H4 using tissue microarrays from a cohort of 199 OPSCC patients with a > 70% staining cutoff for positivity. Concordance was evaluated using percent agreement and Cohen's kappa. The concentrations were evaluated for sensitivity and specificity using high risk HPV RNA in situ hybridization (RNA-ISH) and also correlated with Kaplan-Meier overall survival analysis. Inter-rater agreement was very high between p16 results at each concentration and also with RNA in situ hybridization (p < 0.0001 for all). Agreement between p16 undiluted and 1:5 dilution (agreement 98.2%; Kappa 0.943; p < 0.0001) was very high and between p16 undiluted and 1:10 dilution (agreement 79.2%; Kappa 0.512; p < 0.0001) much lower. Intensity of the staining did decrease with the 1:5 and 1:10 dilutions compared to undiluted, but not in a manner that obviously would change test interpretation or performance. Results suggest that the E6H4 antibody performs well at dilutions of up to 1:5 fold with a minor decrease in staining intensity, minimum loss of sensitivity, and no loss of specificity in OPSCC patients. This could result in reagent and cost savings.
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Affiliation(s)
- James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 3020D Vanderbilt University Hospital, Nashville, TN, 37232-7415, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Jeremy Shelton
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 3020D Vanderbilt University Hospital, Nashville, TN, 37232-7415, USA
| | - Krystle Lang Kuhs
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Derek K Smith
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Sun XS, Michel C, Babin E, De Raucourt D, Péchery A, Gherga E, Géry B, Florescu C, Bourhis J, Thariat J. Approach to oligometastatic disease in head and neck cancer, on behalf of the GORTEC. Future Oncol 2018; 14:877-889. [DOI: 10.2217/fon-2017-0468] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Median survival for recurrent/metastatic head and neck squamous cell cancer (HNSCC) patients is about 10 months after first-line best systemic treatment. We aimed to assess current approaches of oligometastatic HNSCC patients by the analysis of current concept and published data (1995–2017) in this population. Five-year survival rates are over 20% in selected patients who undergo metastasis-directed therapy by either surgery or stereotactic irradiation. Human papillomavirus(+) HNSCC patients have more disseminated metastases but respond more favorably and also benefit from ablative treatments. Treatments of oligometastases are expanding rapidly. Unmet needs include revised imaging follow-up strategies to detect metastases earlier, identification of predictive noninvasive biomarkers for treatment guidance, assessment and corrections of biases in current studies and randomized clinical trials.
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Affiliation(s)
- Xu Shan Sun
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Cécile Michel
- GORTEC, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Emmanuel Babin
- CHU – Normandie Université, Department of Head & Neck Surgery, 14000 Caen, France
| | - Dominique De Raucourt
- Center François Baclesse – Normandie Université, Department of Head & Neck Surgery, 3 Avenue Général Harris, 14000 Caen, France
| | - Adeline Péchery
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Elisabeta Gherga
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Bernard Géry
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Carmen Florescu
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Jean Bourhis
- CHUV. Lausanne, Department of Radio-oncology, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Juliette Thariat
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
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p16 immunohistochemistry in oropharyngeal squamous cell carcinoma: a comparison of antibody clones using patient outcomes and high-risk human papillomavirus RNA status. Mod Pathol 2017; 30:1194-1203. [PMID: 28621317 DOI: 10.1038/modpathol.2017.31] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/02/2017] [Accepted: 03/12/2017] [Indexed: 01/23/2023]
Abstract
High-risk human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas have a more favorable prognosis than HPV-negative ones. p16 immunohistochemistry has been recommended as a prognostic test in clinical practice. Several p16 antibodies are available, and their performance has not been directly compared. We evaluated three commercially available p16 antibody clones (E6H4, JC8 and G175-405) utilizing 199 cases of oropharyngeal squamous cell carcinoma from a tissue microarray, read by three pathologists with three different cutoffs for positivity: any staining, >50% and >75%. Positive predictive values for high-risk HPV status by RNA in situ hybridization for the E6H4, JC8 and G175-405 clones were 98%, 100% and 99% at the 75% cutoff, but negative predictive values were much more variable at 86%, 69% and 56%, respectively. These improved using the 50% cutoff, becoming similar for all three antibodies. Intensity varied substantially, with 85% of E6H4, 72% of JC8 and 67% of G175-405 showing strong (3+) intensity. With Kaplan-Meier survival plots at the 75% cutoff, the E6H4 clone showed the largest differential in disease specific and overall survival between p16-positive and -negative results. Decreasing the cutoff to 50% increased correlation with HPV in situ hybridization and improved the survival differential for the JC8 and G175-405 clones without worsening of performance for the E6H4 clone. Interobserver agreement was also assessed by kappa scores and was highest for the E6H4 clone. Overall, these study results show modest but important performance differences between the three different p16 antibody clones, suggesting that the E6H4 clone performs best because of strongest staining intensity, greatest differential in outcomes between positive and negative results, lowest interobserver variability, and lowest background, nonspecific staining. The results also suggest that a 75% cutoff is very functional but that, in this patient population with high HPV incidence, 50% and any staining cutoffs may be more effective, particularly for the non-E6H4 clones.
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Galloway TJ, Zhang QE, Nguyen-Tan PF, Rosenthal DI, Soulieres D, Fortin A, Silverman CL, Daly ME, Ridge JA, Hammond JA, Le QT. Prognostic Value of p16 Status on the Development of a Complete Response in Involved Oropharynx Cancer Neck Nodes After Cisplatin-Based Chemoradiation: A Secondary Analysis of NRG Oncology RTOG 0129. Int J Radiat Oncol Biol Phys 2016; 96:362-371. [PMID: 27478170 PMCID: PMC5078986 DOI: 10.1016/j.ijrobp.2016.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the relationship between p16 status and the regional response of patients with node-positive oropharynx cancer treated on NRG Oncology RTOG 0129. METHODS AND MATERIALS Patients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on RTOG 0129 were analyzed. Pathologic complete response (pCR) rates in patients treated with a postchemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher exact test. Patients managed expectantly were compared with those treated with a neck dissection. RESULTS Ninety-nine (34%) of 292 patients with node-positive oropharynx cancer and known p16 status underwent a posttreatment neck dissection (p16-positive: n=69; p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range, 17-169) days after completion of chemoradiation. Neither the pretreatment nodal stage (P=.71) nor the postradiation, pre-neck dissection clinical/radiographic neck assessment (P=.42) differed by p16 status. A pCR was more common among p16-positive patients (78%) than p16-negative patients (53%, P=.02) and was associated with a reduced incidence of local-regional failure (hazard ratio 0.33, P=.003). On multivariate analysis of local-regional failure, a test for interaction between pCR and p16 status was not significant (P=.37). One-hundred ninety-three (66%) of 292 of initially node-positive patients were managed without a posttreatment neck dissection. Development of a clinical (cCR) was not significantly influenced by p16-status (P=.42). Observed patients with a clinical nodal CR had disease control outcomes similar to those in patients with a pCR neck dissection. CONCLUSIONS Patients with p16-positive tumors had significantly higher pCR and locoregional control rates than those with p16-negative tumors.
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Affiliation(s)
| | - Qiang Ed Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Denis Soulieres
- Centre Hospitalier de l'Universite de Montreal-Notre Dame, Montréal, Québec, Canada
| | - André Fortin
- L Hotel-Dieu de Quebec, Québec City, Québec, Canada
| | - Craig L Silverman
- The James Brown Cancer Center-University of Louisville, Louisville, Kentucky
| | - Megan E Daly
- University of California Davis Medical Center, Sacramento, California
| | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, California
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Predictive Factors for Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement and Use in Head and Neck Patients Following Intensity-Modulated Radiation Therapy (IMRT) Treatment: Concordance, Discrepancies, and the Role of Gabapentin. Dysphagia 2016; 31:206-13. [PMID: 26753929 DOI: 10.1007/s00455-015-9679-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
The prophylactic placement of a percutaneous endoscopic gastrostomy (PEG) tube in the head and neck cancer (HNC) patient is controversial. We sought to identify factors associated with prophylactic PEG placement and actual PEG use. Since 2010, data regarding PEG placement and use were prospectively recorded in a departmental database from January 2010 to December 2012. HNC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively evaluated from 2010 to 2012. Variables potentially associated with patient post-radiation dysphagia from previous literature, and our experience was evaluated. We performed multivariate logistic regression on these variables with PEG placement and PEG use, respectively, to compare the difference of association between the two arms. We identified 192 HNC patients treated with IMRT. Prophylactic PEG placement occurred in 121 (63.0 %) patients, with PEG use in 97 (80.2 %) patients. PEG placement was associated with male gender (p < .01), N stage ≥ N2 (p < .05), pretreatment swallowing difficulties (p < .01), concurrent chemotherapy (p < .01), pretreatment KPS ≥80 (p = .01), and previous surgery (p = .02). Concurrent chemotherapy (p = .03) was positively associated with the use of PEG feeding by the patient, whereas pretreatment KPS ≥80 (p = .03) and prophylactic gabapentin use (p < .01) were negatively associated with PEG use. The analysis suggests there were discrepancies between prophylactic PEG tube placement and actual use. Favorable pretreatment KPS, no pretreatment dysphagia, no concurrent chemotherapy, and the use of gabapentin were significantly associated with reduced PEG use. This analysis may help refine the indications for prophylactic PEG placement.
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Gillison ML, Restighini C. Anticipation of the Impact of Human Papillomavirus on Clinical Decision Making for the Head and Neck Cancer Patient. Hematol Oncol Clin North Am 2015; 29:1045-60. [DOI: 10.1016/j.hoc.2015.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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The rationale for HPV-related oropharyngeal cancer de-escalation treatment strategies. Contemp Oncol (Pozn) 2015; 19:313-22. [PMID: 26557780 PMCID: PMC4631307 DOI: 10.5114/wo.2015.54389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/08/2015] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment paradigms for head and neck squamous cell cancer (HNSCC) are changing due to the emergence of human papillomavirus-associated tumors (HPV-related), possessing distinct molecular profiles and responses to therapy. Retrospective studies have suggested that HPV-related HNSCCs are more frequently cured than those caused by tobacco. Current clinical trials focus on the reduction of treatment-related toxicity and the development of HPV-targeted therapies. New treatment strategies include: 1) dose reduction of radiotherapy, 2) the use of cetuximab instead of cisplatin for chemo-radiation 3) less invasive surgical options, i.e. trans-oral robotic surgery and trans-oral laser microlaryngoscopy, and 4) more specific treatment attempts, including immunotherapeutic strategies, thanks to increasing comprehension of the molecular background of HPV-related HNSCC. Whereas recently published data shed light on immune mechanisms, other studies have focused on specific vaccination against HPV-related HNSCC. A crucial problem is patient selection to the chosen bias. Truly HPV-related cancers (p16-positive and HPV DNA-positive) with biomarkers for good response to therapy could be included in randomized trials aiming for less severe and better tailored therapy.
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Hasegawa M, Maeda H, Deng Z, Kiyuna A, Ganaha A, Yamashita Y, Matayoshi S, Agena S, Toita T, Uehara T, Suzuki M. Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer. Int J Oncol 2014; 45:1017-26. [PMID: 24969413 PMCID: PMC4121413 DOI: 10.3892/ijo.2014.2504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/02/2014] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate human papillomavirus (HPV) infection as a predictor of concurrent chemoradiotherapy (CCRT) response and indicator of planned neck dissection (PND) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC; stage III/IV). Overall, 39 OPSCC patients (32 men, 7 women; median age 61 years, range 39–79 years) were enrolled. The primary lesion and whole neck were irradiated up to 50.4 Gy, and subsequently the primary site and metastatic lymph nodes were boosted with a further 16.2 Gy. Although several chemotherapy regimens were employed, 82.1% of OPSCC patients received the combination of nedaplatin and 5-fluorouracil. HPV-related OPSCC (16 cases) was defined as both HPV DNA-positive status by polymerase chain reaction and p16INK4a overexpression by immunohistochemistry. Patients with N2 and N3 disease received PND 2–3 months after CCRT completion. Compared to non-responders, CCRT responders showed significantly lower nodal stage (N0 to N2b) and HPV-positive status in univariate analysis. Patients with HPV-related OPSCC had longer time to treatment failure (TTF) than those with HPV-unrelated OPSCC (p=0.040). Three-year TTF was 81.3 and 47.8% in the HPV-related and HPV-unrelated groups, respectively. There were also significant differences in disease-free survival (DFS) between the two OPSCC patient groups (p=0.042). Three-year DFS was 93.8 and 66.7% in patients with HPV-related and HPV-unrelated OPSCC, respectively. Multivariate logistic analysis showed a lower risk of TTF event occurrence in HPV-related OPSCC (p=0.041) than in HPV-unrelated OPSCC. Thus, HPV testing in addition to nodal stage was useful for predicting CCRT response, especially in advanced OPSCC. Because patients who received PND showed moderate locoregional control, PND is an effective surgical procedure for controlling neck lesions in patients with advanced HPV-unrelated disease.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Hiroyuki Maeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Zeyi Deng
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Asanori Kiyuna
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Akira Ganaha
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Yukashi Yamashita
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Sen Matayoshi
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Shinya Agena
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Takafumi Toita
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Takayuki Uehara
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
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