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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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2
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Taniguchi AN, Sutton SR, Nguyen SA, Kejner AE, Albergotti WG. The Lack of Standardized Outcomes for Surgical Salvage of HPV-Positive Recurrent Oropharyngeal Squamous Cell Carcinoma: A Systematic Scoping Review. Cancers (Basel) 2023; 15:2832. [PMID: 37345169 DOI: 10.3390/cancers15102832] [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: 04/08/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Although HPV status is known to provide an improved prognosis in initial treatments of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), it is unclear how it affects patients who receive salvage surgery (SS), which has historically poor survival rates. The purpose of this study was to evaluate the role of SS for patients with locoregional recurrence (LRR) of HPV-positive OPSCC and its impact survival rates. We conducted a scoping review of literature through October 2022 and included 995 individuals. Survival endpoints, such as overall survival (OS), Kaplan-Meier curves, and median post-recurrence survival, were analyzed in addition to demographics. Of all studies, 18.8% (6/32) reported any survival data for SS patients, with the most prevalent reporting 2- and 5-year OS in two studies. Median post-recurrence survival was not reported for SS. These findings reveal the limited and unpredictable reporting of survival-specific data on SS for HPV-positive OPSCC. With limited survival assessment, it is difficult to assess the potential advantages and disadvantages of this therapy to guide clinical decision-making.
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Affiliation(s)
- April N Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Sarah R Sutton
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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3
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Wedekind H, Walz K, Buchbender M, Rieckmann T, Strasser E, Grottker F, Fietkau R, Frey B, Gaipl US, Rückert M. Head and neck tumor cells treated with hypofractionated irradiation die via apoptosis and are better taken up by M1-like macrophages. Strahlenther Onkol 2021; 198:171-182. [PMID: 34665291 PMCID: PMC8789708 DOI: 10.1007/s00066-021-01856-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
Purpose The incidence of head and neck squamous cell carcinomas (HNSCC) is increasing worldwide, especially when triggered by the human papilloma virus (HPV). Radiotherapy has immune-modulatory properties, but the role of macrophages present in HNSCC and having contact with irradiated tumor cells remains unclear. The influence of irradiated (2 × 5Gy) HNSCC cells on the (re-)polarization and phagocytosis of human macrophages, either non-polarized or with a more M1 or M2 phenotype, was therefore investigated. Methods Human monocytes were differentiated with the hematopoietic growth factors M‑CSF (m) or GM-CSF (g) and additionally pre-polarized with either interleukin (IL)-4 and IL-10 or interferon (IFN)-γ and lipopolysaccharides (LPS), respectively. Subsequently, they were added to previously irradiated (2 × 5Gy) and mock-treated HPV-positive (UD-SCC-2) and HPV-negative (Cal33) HNSCC cells including their supernatants. Results The HNSCC cells treated with hypofractionated irradiation died via apoptosis and were strongly phagocytosed by M0m and M2 macrophages. M0g and M1 macrophages phagocytosed the tumor cells to a lesser extent. Irradiated HNSCC cells were better phagocytosed by M1 macrophages compared to mock-treated controls. The polarization status of the macrophages was not significantly changed, except for the expression of CD206 on M2 macrophages, which was reduced after phagocytosis of irradiated HPV-negative cells. Further, a significant increase in the uptake of irradiated HPV-positive cells by M0g macrophages when compared to HPV-negative cells was observed. Conclusion HNSCC cells treated with hypofractionated irradiation foster phagocytosis by anti-tumorigenic M1 macrophages. The data provide the first evidence on the impact of the HPV status of HNSCC cells on the modulation of the macrophage response to irradiated tumor cells.
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Affiliation(s)
- Hanna Wedekind
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Kristina Walz
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thorsten Rieckmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Erwin Strasser
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fridolin Grottker
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Udo S Gaipl
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Michael Rückert
- Translational Radiobiology, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
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Culié D, Lisan Q, Leroy C, Modesto A, Schiappa R, Chamorey E, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Lakdar AB, Temam S, Gorphe P, Guerlain J, Bozec A, Mirghani H. Oropharyngeal cancer: First relapse description and prognostic factor of salvage treatment according to p16 status, a GETTEC multicentric study. Eur J Cancer 2020; 143:168-177. [PMID: 33333482 DOI: 10.1016/j.ejca.2020.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Although Human Papilloma Virus (HPV)-driven oropharyngeal cancer (OPC) prognosis is significantly better than that of other head and neck cancers, up to 25% of cases will recur within 5 years. Data on the pattern of disease recurrence and efficiency of salvage treatment are still sparse. MATERIAL AND METHOD Observational study of all recurrent OPCs diagnosed, following a curative intent treatment, in seven French centers from 2009 to 2014. p16 Immunohistochemistry was used to determine HPV status. Clinical characteristics, distribution of recurrence site, and treatment modalities were compared by HPV tumor status. Overall survival was examined using Kaplan-Meier and multivariate Cox regression modeling. RESULTS 350 recurrent OPC patients (246 p16-negative and 104 p16-positive patients). The site of recurrence was more frequently locoregional for p16-negative patients (65.4% versus 52.9% in p16-positive patients) and metastatic for p16-positive patients (47.1% versus 34.6% in p16-patients, p = 0.03). Time from diagnosis to recurrence did not differ between p16-positive and p16-negative patients (12 and 9.6 months, respectively, p-value = 0.2), as the main site of distant metastasis (all p-values ≥0.10). Overall and relapse-free survival following the first recurrence did not differ according to p16 status (p-values from log-rank 0.30 and 0.40, respectively). In multivariate analysis, prognosis factors for overall survival in p16-negative patients were distant metastasis (HR 2.11, 95% CI 1.30-3.43) and concurrent local and regional recurrences (HR 2.20, 95% CI 1.24-3.88). CONCLUSION With the exception of the initial site of recurrence, the pattern of disease relapse and the efficiency of salvage treatment are not different between p16-positive and negative OPCs.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
| | - Quentin Lisan
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Charlotte Leroy
- Department of Otorhinolaryngology, Lariboisière Hospital, Paris, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Schiappa
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Emmanuel Chamorey
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha B Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Haitham Mirghani
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
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5
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Fleming CW, Ward MC, Woody NM, Joshi NP, Greskovich JF, Rybicki L, Xiong D, Contrera K, Chute DJ, Milas ZL, Frenkel CH, Brickman DS, Carrizosa DR, Ku J, Prendes B, Lamarre E, Lorenz RR, Scharpf J, Burkey BB, Schwartzman L, Geiger JL, Adelstein DJ, Koyfman SA. Identifying an oligometastatic phenotype in HPV-associated oropharyngeal squamous cell cancer: Implications for clinical trial design. Oral Oncol 2020; 112:105046. [PMID: 33129058 DOI: 10.1016/j.oraloncology.2020.105046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with human papillomavirus (HPV) associated squamous cell carcinoma of the oropharynx (SCC-OP) have improved overall survival (OS) after distant metastasis (DM) compared to HPV negative patients. These patients may be appropriate candidates for enrollment on clinical trials evaluating the efficacy of metastasis-directed therapy (MDT). This study seeks to identify prognostic factors associated with OS after DM, which could serve as enrollment criteria for such trials. MATERIALS AND METHODS From an IRB approved multi-institutional database, we retrospectively identified patients with HPV/p16 positive SCC-OP diagnosed between 2001 and 2018. Patterns of distant failure were assessed, including number of lesions at diagnosis and sites of involvement. The primary outcome was OS after DM. Prognostic factors for OS after DM were identified with Cox proportional hazards. Stepwise approach was used for multivariable analysis. RESULTS We identified 621 patients with HPV-associated SCC-OP, of whom 82 (13.2%) were diagnosed with DM. Median OS after DM was 14.6 months. On multivariable analysis, smoking history and number of lesions were significantly associated with prolonged OS. Median OS after DM by smoking (never vs ever) was 37.6 vs 11.2 months (p = 0.006), and by lesion number (1 vs 2-4 vs 5 or more) was 41.2 vs 17.2 vs 10.8 months (p = 0.007). CONCLUSION Among patients with newly diagnosed metastatic HPV-associated SCC-OP, lesion number and smoking status were associated with significantly prolonged overall survival. These factors should be incorporated into the design of clinical trials investigating the utility of MDT, with or without systemic therapy, in this population.
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Affiliation(s)
- Christopher W Fleming
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Matthew C Ward
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nikhil P Joshi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - John F Greskovich
- Department of Radiation Oncology, Cleveland Clinic Florida, Weston, FL, United States
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic Learner Research Institute, Cleveland, OH, United States
| | - David Xiong
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Kevin Contrera
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic, Cleveland, OH, United States
| | - Zvonimir L Milas
- Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Catherine H Frenkel
- Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Daniel S Brickman
- Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Daniel R Carrizosa
- Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Jamie Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brandon Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Eric Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert R Lorenz
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Joseph Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brian B Burkey
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Larisa Schwartzman
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jessica L Geiger
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - David J Adelstein
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
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6
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Su W, Rajeev-Kumar G, Kang M, Posner M, Liu JT, Westra W, Miles BA, Gupta V, Sharma S, Misiukiewicz K, Genden E, Bakst RL. Long-term outcomes in patients with recurrent human papillomavirus-positive oropharyngeal cancer after upfront transoral robotic surgery. Head Neck 2020; 42:3490-3496. [PMID: 32776411 DOI: 10.1002/hed.26396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Clinical course following failure of human papillomavirus (HPV)-positive oropharyngeal cancers (HPV + OPC) is poorly understood. This study aims to characterize disease course following failure after transoral robotic surgery (TORS). METHODS We identified patients with HPV + OPC-treated upfront with TORS at our institution from 2007 to 2017. HPV status was confirmed with immunohistochemistry or HPV DNA polymerase chain reaction. Patient characteristics, treatment modalities, and post-recurrence outcomes were analyzed for the recurrent cohort. RESULTS Of the 317 HPV + OPC patients, 28 (8.8%) experienced recurrence, all of HPV 16/18 subtypes. Median post-recurrence survival was 19.8 months (range 2.3-195.8 months) in the 12 locoregional and 16 months (range 2.4-79.5 months) in the 14 distant failures. Sixteen are alive with a median of 39.8 months (range 5.5-209.4 months) after retreatment. CONCLUSION This is one of the largest series evaluating survival following TORS failure in HPV + OPC. Despite failure, long-term survival and durable remission are possible with single-modal or multiple-modal salvage treatment.
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Affiliation(s)
- William Su
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Greeshma Rajeev-Kumar
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Martin Kang
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall Posner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Westra
- Department of Anatomic and Clinical Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof Misiukiewicz
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Hematology Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Özcan-Wahlbrink M, Schifflers C, Riemer AB. Enhanced Radiation Sensitivity of Human Papillomavirus-Driven Head and Neck Cancer: Focus on Immunological Aspects. Front Immunol 2019; 10:2831. [PMID: 31849993 PMCID: PMC6901628 DOI: 10.3389/fimmu.2019.02831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/18/2019] [Indexed: 12/29/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC), emerging in the mucosa of the upper aerodigestive tract, are associated with either the classical risk factors, tobacco and alcohol consumption, or with infections with high-risk types of the human papillomavirus (HPV). Depending on the involvement of HPV, HNSCC follow different pathways of carcinogenesis and show distinct clinical presentations regarding survival, prognosis and treatment response. For instance, HPV-driven HNSCC exhibit an enhanced radiation response compared to their typically radioresistant HPV-negative counterparts. Although radiosensitivity of HNSCC has been studied by many research groups, the major causes for the difference in radiation responses between HPV-driven and HPV-negative HNSCC are still an open question. In this mini review, we discuss the reported cellular and immunological factors involved in the enhanced radiation response in HPV-driven HNSCC, focusing on the vital role of the immune response in the outcome of HNSCC radiotherapy.
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Affiliation(s)
- Mine Özcan-Wahlbrink
- Immunotherapy and Immunoprevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Molecular Vaccine Design, German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany
| | - Christoph Schifflers
- Immunotherapy and Immunoprevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Molecular Vaccine Design, German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany.,Cell Biology Research Unit (URBC)-Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Angelika B Riemer
- Immunotherapy and Immunoprevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Molecular Vaccine Design, German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany
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8
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Tiedemann D, Jakobsen KK, von Buchwald C, Grønhøj C. Systematic review on location and timing of distant progression in human papillomavirus-positive and human papillomavirus-negative oropharyngeal squamous cell carcinomas. Head Neck 2018; 41:793-798. [DOI: 10.1002/hed.25458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/31/2018] [Accepted: 08/27/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Daniel Tiedemann
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; University Hospital Rigshospitalet; Copenhagen Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; University Hospital Rigshospitalet; Copenhagen Denmark
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9
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Hanna GJ, Kacew A, Chau NG, Shivdasani P, Lorch JH, Uppaluri R, Haddad RI, MacConaill LE. Improved outcomes in PI3K-pathway-altered metastatic HPV oropharyngeal cancer. JCI Insight 2018; 3:122799. [PMID: 30185662 DOI: 10.1172/jci.insight.122799] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023] Open
Abstract
While it has been recognized that human papillomavirus-associated (HPV-associated) oropharyngeal cancer (OPC) portends an improved prognosis, distinct patterns of disease recurrence have emerged. Molecular characterization of this subset of HPV patients remains unexplored. We evaluated 52 metastatic HPV+ OPC patients from our institution and paired massively parallel sequencing data with clinical parameters and survival outcomes in 81% of patients. Genomic data were then compared with 2 molecularly defined, curable HPV+ cohorts. Metastatic HPV+ OPC patients with pulmonary-only metastases demonstrated worse outcomes. Nonexclusive somatic alterations in KMT2D and PIK3CA were most frequent, with PRKDC alterations occurring at higher frequency when compared with all sequenced HPV+ OPC patients. PI3K pathway alterations were associated with improved outcomes among metastatic HPV+ OPC patients. We demonstrate subtle differences in the mutational landscape between curable and metastatic HPV+ OPC populations, with a trend towards more frequent DNA repair protein alterations in the latter. We demonstrate improved outcomes when PI3K pathway alterations are present in these patients. We provide molecular insights for this important HPV+ subgroup that have significant therapeutic implications.
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Affiliation(s)
- Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alec Kacew
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nicole G Chau
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Department of Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura E MacConaill
- Department of Pathology and.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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10
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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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