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Deintensification Candidate Subgroups In Human Papillomavirus-related Oropharyngeal Cancer According To Minimal Risk Of Distant Metastasis.

B O'Sullivan, Shao Hui Huang, Lillian L. Siu, John N. Waldron, Helen Zhao, Bayardo Perez-Ordóñez, Ilan Weinreb, John Kim, Jolie Ringash, Andrew J S Bayley, Laura A. Dawson, Andrew Hope, John Cho, Jonathan Irish, Ralph W. Gilbert, Patrick J. Gullane, Angela Hui, Fei-fei Liu, Eric Chen, Wei Xu
Published 2013 · Medicine
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PURPOSE To define human papillomavirus (HPV) -positive oropharyngeal cancers (OPC) suitable for treatment deintensification according to low risk of distant metastasis (DM). PATIENTS AND METHODS OPC treated with radiotherapy (RT) or chemoradiotherapy (CRT) from 2001 to 2009 were included. Outcomes were compared for HPV-positive versus HPV-negative patients. Univariate and multivariate analyses identified outcome predictors. Recursive partitioning analysis (RPA) stratified the DM risk. RESULTS HPV status was ascertained in 505 (56%) of 899 consecutive OPCs. Median follow-up was 3.9 years. HPV-positive patients (n = 382), compared with HPV-negative patients (n = 123), had higher local (94% v 80%, respectively, at 3 years; P < .01) and regional control (95% v 82%, respectively; P < .01) but similar distant control (DC; 90% v 86%, respectively; P = .53). Multivariate analysis identified that HPV negativity (hazard ratio [HR], 2.9; 95% CI, 2.0 to 5.0), N2b-N3 (HR, 2.9; 95% CI, 1.8 to 4.9), T4 (HR, 1.8; 95% CI, 1.2 to 2.9), and RT alone (HR, 1.8; 95% CI, 1.1 to 2.5) predicted a lower recurrence-free survival (RFS; all P < .01). Smoking pack-years > 10 reduced overall survival (HR, 1.72; 95% CI, 1.1 to 2.7; P = .03) but did not impact RFS (HR, 1.1; 95% CI, 0.7 to 1.9; P = .65). RPA segregated HPV-positive patients into low (T1-3N0-2c; DC, 93%) and high DM risk (N3 or T4; DC, 76%) groups and HPV-negative patients into different low (T1-2N0-2c; DC, 93%) and high DM risk (T3-4N3; DC, 72%) groups. The DC rates for HPV-positive, low-risk N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT, but the rate was lower in the N2c subset managed by RT alone (73% v 92% for CRT; P = .02). CONCLUSION HPV-positive T1-3N0-2c patients have a low DM risk, but N2c patients from this group have a reduced DC when treated with RT alone and seem less suited for deintensification strategies that omit chemotherapy.
This paper references
Outcomes of HPV-related oropharyngeal cancer patients treated by radiotherapy alone using altered fractionation.
B O'Sullivan (2012)
Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer.
Maura L. Gillison (2012)
Analysis of Censored Data: Survival Trees
Heping Zhang (1999)
Comparative prognostic value of HPV16 E6 mRNA compared with in situ hybridization for human oropharyngeal squamous carcinoma.
Wei Shi (2009)
Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer.
George P. Browman (1993)
Head and Neck Cancer Among Lifelong Never-Smokers and Ever-Smokers: Matched-Pair Analysis of Outcomes After Radiation Therapy
Allen M Chen (2011)
Tobacco Use in Human Papillomavirus–Positive Advanced Oropharynx Cancer Patients Related to Increased Risk of Distant Metastases and Tumor Recurrence
Jessica H. Maxwell (2010)
Evidence for a causal association between human papillomavirus and a subset of head and neck cancers.
Maura L. Gillison (2000)
Optimising the therapeutic ratio in head and neck cancer.
June Corry (2010)
Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial.
Gregory Weinstein (2010)
Multiple Imputation after 18+ Years
Donald B. Rubin (1996)
Patterns of failure and histopathologic outcome predictors following definitive radiotherapy and planned neck dissection with residual disease.
Shao Hui Huang (2012)
Point-of-care outcome assessment in the cancer clinic: audit of data quality.
Karen W Y Wong (2010)
Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a United States multicenter study.
Bruce H. Haughey (2011)
International Union Against Cancer (UICC)
Barry Trevor Turner (1999)
Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma--a prospective study.
Camilla Molich Hoff (2012)
Atypical clinical behavior of p16-confirmed HPV-related oropharyngeal squamous cell carcinoma treated with radical radiotherapy.
Shao Hui Huang (2012)
Analysing and interpreting competing risk data.
Melania Pintilie (2007)
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)
James D. Cox (1995)
Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates.
Peter Peduzzi (1995)
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients.
Jean-Pierre Pignon (2009)
Multiple primary malignant tumors. A survey of the literature and a statistical study
Stephen M. Warren (1932)
AJCC Cancer Staging Manual
Mahul B. Amin (2002)
Matched-pair analysis of survival of never smokers and ever smokers with squamous cell carcinoma of the head and neck.
Kristen B. Pytynia (2004)
Matted nodes: poor prognostic marker in oropharyngeal squamous cell carcinoma independent of HPV and EGFR status.
Matthew E Spector (2012)
A randomized phase III trial (RTOG 0522) of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III-IV head and neck squamous cell carcinomas (HNC).
K Kian Ang (2011)
Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcome.
Allen M Chen (2011)
Human papillomavirus and survival of patients with oropharyngeal cancer.
K Kian Ang (2010)
Survival analysis of head and neck squamous cell carcinoma: influence of smoking and drinking.
F. Farshadpour (2011)
Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer.
David M. Brizel (1998)
The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial.
Pernille Lassen (2011)
Concurrent cisplatin and radiation versus cetuximab and radiation for locally advanced head-and-neck cancer.
Lawrence Koutcher (2011)

This paper is referenced by
Oncology scan--rethinking treatment strategies for cancers of the larynx and pharynx.
Giuseppe Sanguineti (2013)
Integrating genomics in head and neck cancer treatment: Promises and pitfalls.
Juliette Thariat (2015)
Incidence trends in head and neck squamous cell carcinoma in Slovenia, 1983–2009: role of human papillomavirus infection
Primož Strojan (2014)
The Influence of Diabetes Mellitus and Metformin on Distant Metastases in Oropharyngeal Cancer: A Multicenter Study.
Daniel E. Spratt (2016)
Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines
Hisham Mehanna (2016)
HPV-related squamous cell carcinoma of oropharynx: a review.
Siavash Rahimi (2020)
Role of human papillomavirus and p16 staining in a patient with head and neck cancer presenting with a synchronous lung nodule: a case report and review of the literature.
Marcelo Bonomi (2015)
Quality of Life of Postoperative Photon versus Proton Radiation Therapy for Oropharynx Cancer
Saniya Sharma (2018)
Value of transoral surgery for human papillomavirus-mediated oropharyngeal cancer: validation of a new staging system in Japanese patients
Eiko Kimura (2019)
Avaluació de factors mol·leculars associats a la resposta a anticossos monoclonals anti-EGFR: integració amb tractaments de radioteràpia en càncer de cap i coll
Sergio Benavente Norza (2016)
Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma.
Anthony Noor (2019)
Assessment of the Tumor Redox Status in Head and Neck Cancer by 62Cu-ATSM PET
Tetsuya Tsujikawa (2016)
High metastatic node number, not extracapsular spread or N-classification is a node-related prognosticator in transorally-resected, neck-dissected p16-positive oropharynx cancer.
Parul Khare Sinha (2015)
Impact of retropharyngeal adenopathy on distant control and survival in HPV-related oropharyngeal cancer treated with chemoradiotherapy.
Stuart E. Samuels (2015)
Sequential and Concurrent Chemoradiation: State of the Art.
Nicole G. Chau (2015)
Clinical outcomes in elderly patients with human papillomavirus-positive squamous cell carcinoma of the oropharynx treated with definitive chemoradiation therapy.
Sheela Hanasoge (2016)
Concurrent use of cisplatin or cetuximab with definitive radiotherapy for locally advanced head and neck squamous cell carcinomas
Antonin Levy (2014)
Deregulation of SYCP2 predicts early stage human papillomavirus‐positive oropharyngeal carcinoma: A prospective whole transcriptome analysis
Liam Masterson (2015)
Detection of HPV infection in head and neck cancers: Promise and pitfalls in the last ten years: A meta-analysis
Carolin Götz (2019)
Carcinoma escamoso de orofaringe relacionado con el virus del papiloma humano
Edelberto Gámez Pérez (2018)
University of Southern Denmark Oncogenic drivers in 11q13 associated with prognosis and response to therapy in advanced oropharyngeal carcinomas Barros-Filho,
M. C. Reis-Rosa (2019)
Safety and Effectiveness of De-escalated Radiation Dose in T1-3 Nasopharyngeal Carcinoma: A Propensity Matched Analysis
Xiaofei Wang (2019)
Head and Neck Cancer
Kristina H. Young (2013)
Aktueller Status der Therapie und Prophylaxe des Oropharynxkarzinoms
Andreas Dietz (2018)
Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx.
Bruce H. Haughey (2016)
E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx- ECOG-ACRIN Cancer Research Group.
Shanthi Marur (2017)
Current Status and Future Directions of Treatment Deintensification in Human Papilloma Virus-associated Oropharyngeal Squamous Cell Carcinoma.
Bhishamjit S. Chera (2018)
Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States.
Colin T. Murphy (2016)
Annette M Lim (2015)
HPV positive oropharyngeal cancer and treatment deintensification: how pertinent is it?
Sarbani Ghosh Laskar (2015)
Epidemiological characteristics of oral and oropharyngeal squamous cell carcinoma
Hester S. van Monsjou (2015)
Human Papillomavirus and Oropharyngeal Cancer Stage.
Maura L. Gillison (2016)
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