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The relationship between patterns of failure and human papilloma virus (HPV) status for squamous cell carcinoma of the oropharynx after definitive chemoradiotherapy: what role does elective nodal irradiation play?

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The goal of this study is to evaluate patterns of failure and survival in relation to HPV/p16 status in patients with oropharyngeal (OP) cancers who were treated with chemoradiotherapy.

Methods

A retrospective review of 271 consecutive head and neck cancer patients with known HPV/p16 status treated between 2009 and 2012 were reviewed. Ninety-four were identified OP cancers. Ninety-five percent of patients were treated with intensity-modulated radiation therapy (IMRT) with or without systemic therapy. Diagnostic imaging was coregistered with the planning CT scan in order to assess radiation dose statistics for the failure site.

Results

The median follow-up time was 30 months. The estimated 3-year overall survival for the cohort was 63 %. There was a trend for improved survival in HPV/p16+ patients compared to HPV/p16− patients (75 vs 58 %, p = 0.052). Heavy smoking was related to worse survival. There was a nonsignificant increase in locoregional failure (15.4 vs 2.8 %, p = 0.127) and distant metastasis (12.5 vs 1.5 %, p = 0.108) in HPV/p16− compared to HPV/p16+ tumors. No neck failures occurred in the HPV/p16+ patients, while six neck failures occurred in HPV/p16− patients. There was no difference between elective nodal doses between the two groups. A lower mean elective nodal dose was significant for predicting neck failure (44.54Gy vs 55.19Gy, p = 0.042).

Conclusion

HPV/p16− patients have trends toward worse overall survival, locoregional recurrence, and distant metastasis. Lower elective nodal doses in HPV/p16− patients may increase the risk for elective neck failure.

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Conflicts of interest

Ram Narayan, Joseph Shaughnessy, Craig Silverman, Jeffrey Bumpous, Kevin Potts, Rebecca Redman, Elizabeth Cash, Christine Swanson, and Liz Wilson declare that they have no conflicts on interest.

Neal Dunlap has received an honorarium from the Institute of Graduate Medical Education for educational lectures.

IRB Statement

IRB permission was obtained prior to conducting this retrospective analysis. A complete waiver was placed in each patient’s chart. IRB # BCC-13.0145

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Authors and Affiliations

  1. University of Louisville, 529 South Jackson St., Louisville, KY, 40202, USA

    Ram Narayan

  2. Department of Radiation Oncology, University of Louisville, 529 South Jackson St., Louisville, KY, 40202, USA

    Joseph Shaughnessy, Craig Silverman, Christine Swanson & Neal E. Dunlap

  3. Department of Surgery Division of Otolaryngology, Head and Neck Surgery, University of Louisville, 529 South Jackson St., Louisville, KY, 40202, USA

    Jeffrey Bumpous, Kevin Potts & Elizabeth Cash

  4. Division of Hematology and Oncology, Department of Internal Medicine, University of Louisville, 529 South Jackson St., Louisville,, KY, 40202, USA

    Rebecca Redman

  5. Oncology Nurse Navigator Head and Neck Multidisciplinary Clinic James Graham Brown Cancer Center, 529 South Jackson St., Louisville, KY, 40202, USA

    Liz Wilson

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  1. Ram Narayan
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Correspondence to Neal E. Dunlap.

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Narayan, R., Shaughnessy, J., Silverman, C. et al. The relationship between patterns of failure and human papilloma virus (HPV) status for squamous cell carcinoma of the oropharynx after definitive chemoradiotherapy: what role does elective nodal irradiation play?. J Radiat Oncol 4, 47–53 (2015). https://doi.org/10.1007/s13566-014-0174-3

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  • DOI: https://doi.org/10.1007/s13566-014-0174-3

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