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Kornfeld B, Taha A, Kyang L, Sim HW, Dewhurst S, McCloy R, Chin V, Earls P, Parker A, Leavers B, Forstner D, Floros P, Crawford J, Gallagher R. Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single-centre retrospective Australian study. J Robot Surg 2024; 18:226. [PMID: 38806847 PMCID: PMC11133022 DOI: 10.1007/s11701-024-01910-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/09/2024] [Indexed: 05/30/2024]
Abstract
We present a cohort review of TORS resection for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) and its associated oncological outcomes spanning a 10-year period. A retrospective case series review was performed of patients undergoing primary surgical treatment for HPV-associated OPSCC through the St. Vincent's Head and Neck Cancer service from 2011 to 2022. The primary outcomes were to investigate complete resection of the primary tumour, rates of recurrence, and survival analysis. Secondary outcomes included complications, rates of adjuvant therapy, sites of recurrence and rates of percutaneous endoscopic gastrostomy (PEG). 184 patients underwent TORS-based therapy with neck dissection, and guideline-directed adjuvant therapy for HPV-associated OPSCC. Our median follow-up was 46 months. The positive margin rate on final histopathology analysis was 10.9%. Adjuvant therapy was indicated in 85 patients (46%). The local recurrence rate was 10.9% with the majority (80%) of patients recurring in the first 3 years since treatment. The disease-specific survival at 3 years was 98.6% and at 5 years was 94.4%. The 3-year and 5-year OS for the cohort was 96.7% and 92.5%, respectively. The presence of extranodal extension and positive margins were associated with increased risk of recurrence, whereas adjuvant therapy was found to be a protective factor for both overall recurrence and survival. Major complications occurred in 12 patients (6.5%), resulting in one death. This study has demonstrated that primary surgical therapy for HPV-associated OPSCC is a safe and effective treatment modality with low local recurrence and complication rates, and overall survival benefits.
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Affiliation(s)
- Belen Kornfeld
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia.
- Department of Medicine, Notre Dame University, Sydney, NSW, 2010, Australia.
| | - Ahmed Taha
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Lee Kyang
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Hao-Wen Sim
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Suzannah Dewhurst
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia
| | - Rachael McCloy
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Vanessa Chin
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Peter Earls
- Department of Anatomical Pathology, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Andrew Parker
- Department of Anatomical Pathology, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Brett Leavers
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Dion Forstner
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
- GenesisCare, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Peter Floros
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Julia Crawford
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Richard Gallagher
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- School of Medicine, Notre Dame University, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
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Gorphe P, Moya-Plana A, Guerlain J, Tao Y, Nguyen F, Breuskin I, Blanchard P, Temam S. Disease-free time stratification in locally recurrent head and neck carcinoma after definitive radiotherapy or chemoradiotherapy. Eur Arch Otorhinolaryngol 2021; 279:3063-3069. [PMID: 34648050 DOI: 10.1007/s00405-021-07116-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no standard definition of disease-free interval before local recurrence after treatment in head and neck carcinoma (HNSCC). We evaluated an easy-to-use stratification and its association with survival in a large cohort of patients. METHODS We performed a retrospective cohort analysis of prognostic variables in 325 HNSCC patients with a local recurrence after definitive radiotherapy or concurrent chemoradiotherapy. Endpoints were overall survival (OS) and post-recurrence survival (PRS). RESULTS Variables associated with the survival were the patient age (OS p < 0.0001, PRS p < 0.0001), the initial disease stage (OS p = 0.24, PRS p = 0.0358), localization (OS p = 0.012, PRS p = 0.0002), a complete initial response to treatment (OS p < 0.0001, PRS p = 0.019), synchronous regional or distant metastatic disease (OS p = 0.0094, PRS p < 0.0001), a salvage surgery (OS p < 0.0001, PRS p < 0.0001) and time to recurrence (OS p = 0.0002, PRS p = 0.0029). Time to recurrence could be stratified between specific prognostic time categories that comprised disease persistence, early recurrence (< 12 months), standard recurrence (12 months-5 years) and late recurrence (> 5 years). CONCLUSION In HNSCC patients, time to local recurrence is a prognostic variable that can be defined using an easy-to-use stratification.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Joanne Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Yungan Tao
- Department of Radiotherapy, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - France Nguyen
- Department of Radiotherapy, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pierre Blanchard
- Department of Radiotherapy, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
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Carey RM, Brody RM, Shimunov D, Shinn JR, Mady LJ, Rajasekaran K, Cannady SB, Lin A, Lukens JN, Bauml JM, Cohen RB, Basu D, O'Malley BW, Weinstein GS, Newman JG. Locoregional Recurrence in p16-Positive Oropharyngeal Squamous Cell Carcinoma After TORS. Laryngoscope 2021; 131:E2865-E2873. [PMID: 34076275 DOI: 10.1002/lary.29659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To analyze the patterns, risk factors, and salvage outcomes for locoregional recurrences (LRR) after treatment with transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC). STUDY DESIGN Retrospective analysis of HPV+ OPSCC patients completing primary TORS, neck dissection, and NCCN-guideline-compliant adjuvant therapy at a single institution from 2007 to 2017. METHODS Features associated with LRR, detailed patterns of LRR, and outcomes of salvage therapy were analyzed. Disease-free survival (DFS) and overall survival (OS) were calculated for subgroups of patients receiving distinct adjuvant treatments. RESULTS Of 541 patients who completed guideline-indicated therapy, the estimated 5-year LRR rate was 4.5%. There were no identifiable clinical or pathologic features associated with LRR. Compared to patients not receiving adjuvant therapy, those who received indicated adjuvant radiation alone had a lower risk of LRR (HR 0.28, 95% CI [0.09-0.83], P = .023), but there was no difference in DFS (P = .21) and OS (P = .86) between adjuvant therapy groups. The 5-year OS for patients who developed LRR was 67.1% vs. 93.9% for those without LRR (P < .001). Patients who initially received adjuvant chemoradiation and those suffering local, in-field, and/or retropharyngeal node recurrences had decreased disease control after salvage therapy. CONCLUSION LRR rates are low for HPV+ OPSCCs completing TORS and guideline-compliant adjuvant therapy. Patients without indication for adjuvant therapy more often suffer LRR, but these recurrences are generally controllable by salvage therapy. Improved understanding of the patterns of recurrence most amenable to salvage therapy may guide treatment decisions, counseling, and adjuvant therapy de-escalation trials. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - David Shimunov
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Justin R Shinn
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Leila J Mady
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Steven B Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John N Lukens
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Joshua M Bauml
- Department of Internal Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Roger B Cohen
- Department of Internal Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Devraj Basu
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Bert W O'Malley
- University of Maryland Medical Center, Baltimore, Maryland, U.S.A
| | - Gregory S Weinstein
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Haider SP, Sharaf K, Zeevi T, Baumeister P, Reichel C, Forghani R, Kann BH, Petukhova A, Judson BL, Prasad ML, Liu C, Burtness B, Mahajan A, Payabvash S. Prediction of post-radiotherapy locoregional progression in HPV-associated oropharyngeal squamous cell carcinoma using machine-learning analysis of baseline PET/CT radiomics. Transl Oncol 2020; 14:100906. [PMID: 33075658 PMCID: PMC7568193 DOI: 10.1016/j.tranon.2020.100906] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
Radiomics quantitatively captures visually inappreciable imaging features. PET/CT radiomics provides wholistic metabolic and structural tumor characterization. Machine-learning algorithms can generate radiomics-based biomarkers for OPSCC. PET/CT radiomics can predict post-radiotherapy locoregional progression in HPV-associated OPSCC. Such biomarkers may improve patient selection for treatment de-intensification trials.
Locoregional failure remains a therapeutic challenge in oropharyngeal squamous cell carcinoma (OPSCC). We aimed to devise novel objective imaging biomarkers for prediction of locoregional progression in HPV-associated OPSCC. Following manual lesion delineation, 1037 PET and 1037 CT radiomic features were extracted from each primary tumor and metastatic cervical lymph node on baseline PET/CT scans. Applying random forest machine-learning algorithms, we generated radiomic models for censoring-aware locoregional progression prognostication (evaluated by Harrell's C-index) and risk stratification (evaluated in Kaplan-Meier analysis). A total of 190 patients were included; an optimized model yielded a median (interquartile range) C-index of 0.76 (0.66-0.81; p = 0.01) in prognostication of locoregional progression, using combined PET/CT radiomic features from primary tumors. Radiomics-based risk stratification reliably identified patients at risk for locoregional progression within 2-, 3-, 4-, and 5-year follow-up intervals, with log-rank p-values of p = 0.003, p = 0.001, p = 0.02, p = 0.006 in Kaplan-Meier analysis, respectively. Our results suggest PET/CT radiomic biomarkers can predict post-radiotherapy locoregional progression in HPV-associated OPSCC. Pending validation in large, independent cohorts, such objective biomarkers may improve patient selection for treatment de-intensification trials in this prognostically favorable OPSCC entity, and eventually facilitate personalized therapy.
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Affiliation(s)
- Stefan P Haider
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 789 Howard Ave, PO Box 208042, New Haven, CT 06519, United States; Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Kariem Sharaf
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Tal Zeevi
- Center for Translational Imaging Analysis and Machine Learning, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
| | - Philipp Baumeister
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christoph Reichel
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - Reza Forghani
- Department of Diagnostic Radiology and Augmented Intelligence & Precision Health Laboratory (AIPHL), McGill University Health Centre & Research Institute, 1650 Cedar Avenue, Montreal, Quebec QC H3G 1A4, Canada
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, United States
| | - Alexandra Petukhova
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 789 Howard Ave, PO Box 208042, New Haven, CT 06519, United States
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06520, United States
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, 310 Cedar Street, New Haven, CT 06520, United States
| | - Chi Liu
- Division of Bioimaging Sciences, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
| | - Barbara Burtness
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, 25 York Street, New Haven, CT 06520, United States
| | - Amit Mahajan
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 789 Howard Ave, PO Box 208042, New Haven, CT 06519, United States
| | - Seyedmehdi Payabvash
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 789 Howard Ave, PO Box 208042, New Haven, CT 06519, United States.
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