Skip to main content
SpringerLink
Log in

Outcomes of P16 positive oropharyngeal squamous cell carcinoma treated with surgery and adjuvant IMRT

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

This study compares the outcomes of patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC) treated with surgery followed by adjuvant radiotherapy (aRT) or chemoradiotherapy (aCRT).

Methods

From 1997 to 2009, of 376 patients with OPSCC, 97 were p16+ and eligible: 51 received aRT and 46 received aCRT. Univariate and multivariate Cox regression, and propensity score analyses were performed.

Results

The 5-year locoregional failure (LRF) and distant metastases (DM) rates for the aRT and aCRT groups were 4 versus 0 % and 10 versus 9 %, respectively. The following were associated with a worse OS and DFS on multivariate analysis: pathologic T3/T4 stage (OS p = 0.03; DFS p = 0.02), age ≥55 years (OS p = 0.02; DFS p = 0.01), and a smoking history (OS p = 0.02; DFS p = 0.04). In multivariate and propensity score analyses, aCRT did not have a significant effect on OS, DFS, and DMFS.

Conclusions

In this retrospective study of postoperative p16+, stage III–IVb OPSCC patients receiving aRT or aCRT, we did not find a benefit in OS, DFS, or DMFS with the addition of chemotherapy to IMRT. Given the predominant DM failure pattern in this surgical series, novel systemic strategies are needed. These data warrant further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ang KK, Harris J, Gillison ML (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. New Eng J Med 363(1):24–35. doi:10.1056/NEJMoa0912217

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang K-K, Lefèbvre JL (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27(10):843–850. doi:10.1002/hed.20279

    Article  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network.  Head and Neck Cancers (Version 2.2014). http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 3 Oct 2014

  4. Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH (2012) Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer 118(14):3519–3530. doi:10.1002/cncr.26671

    Article  CAS  PubMed  Google Scholar 

  5. Steiner W, Ambrosch P, Knappe M (2001) Endoscopic laser surgery of the upper aerodigestive tract: with special emphasis on cancer surgery. Thieme Medical Publishers, New York

    Google Scholar 

  6. Rich JT, Milov S, Lewis JS Jr, Thorstad WL, Adkins DR, Haughey BH (2009) Transoral laser microsurgery (TLM) +/− adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope 119(9):1709–1719. doi:10.1002/lary.20552

    Article  PubMed  Google Scholar 

  7. Setton J, Caria N, Romanyshyn J, Koutcher L, Wolden SL, Zelefsky MJ, Rowan N, Sherman EJ, Fury MG, Pfister DG, Wong RJ, Shah JP, Kraus DH, Shi W, Zhang Z, Schupak KD, Gelblum DY, Rao SD, Lee NY (2012) Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: an update of the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 82(1):291–298. doi:10.1016/j.ijrobp.2010.10.041

    Article  PubMed  Google Scholar 

  8. Daly ME, Le Q-T, Maxim PG, Loo BW, Kaplan MJ, Fischbein NJ, Pinto H, Chang DT (2010) Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 76(5):1339–1346. doi:10.1016/j.ijrobp.2009.04.006

    Article  PubMed  Google Scholar 

  9. Haughey BH, Sinha P (2012) Prognostic factors and survival unique to surgically treated p16+ oropharyngeal cancer. Laryngoscope 122(S2):S13–S33

    Article  PubMed  Google Scholar 

  10. Byrd SA, Spector ME, Light E, Walline H, Komarck C, Moyer JS, Prince ME, Wolf GT, Chepeha DB, McHugh JB, Worden FP, Eisbruch A (2012) Understanding the predictive role of smoking in human papillomavirus positive advanced oropharyngeal squamous cell carcinoma. Paper presented at the 8th International Conference on Head and Neck Cancer, Toronto, ON, Canada

  11. Eisbruch A, Harris J, Garden AS, Chao CKS, Straube W, Harari PM, Sanguineti G, Jones CU, Bosch WR, Ang KK (2010) Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys 76(5):1333–1338. doi:10.1016/j.ijrobp.2009.04.011

    Article  PubMed Central  PubMed  Google Scholar 

  12. Garden AS, Morrison WH, Wong P-F, Tung SS, Rosenthal DI, Dong L, Mason B, Perkins GH, Ang KK (2007) Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 67(2):438–444. doi:10.1016/j.ijrobp.2006.08.078

    Article  PubMed Central  PubMed  Google Scholar 

  13. Huang K, Xia P, Chuang C, Weinberg V, Glastonbury CM, Eisele DW, Lee NY, Yom SS, Phillips TL, Quivey JM (2008) Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma. Cancer 113(3):497–507. doi:10.1002/cncr.23578

    Article  PubMed  Google Scholar 

  14. Lawson JD, Otto K, Chen A, Shin DM, Davis L, Johnstone PAS (2008) Concurrent platinum-based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base. Head Neck 30(3):327–335. doi:10.1002/hed.20694

    Article  PubMed  Google Scholar 

  15. Yao M, Nguyen T, Buatti JM, Dornfeld KJ, Tan H, Wacha J, Bayouth JE, Clamon GH, Funk GF, Smith RB, Chang K, Hoffman HT (2006) Changing failure patterns in oropharyngeal squamous cell carcinoma treated with intensity modulated radiotherapy and implications for future research. Am J Clin Oncol 29(6):606–612. doi:10.1097/01.coc.0000242294.89536.d6

    Article  PubMed  Google Scholar 

  16. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. doi:10.1056/NEJMoa032641

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Issam El Naqa, Ph.D., and Joe O. Deasy, Ph.D., for their advice. This research project was supported in part by the Biostatistics Core of the Alvin J. Siteman Cancer Center.

Conflict of interest statement

Hiram A. Gay, Jingxia Liu, Christopher R. Spencer, James S. Lewis, Jr., Jason Diaz, Brian Nussenbaum, Jay F. Piccirillo, Daniel J. Ferraro, Tanya Wildes, Parul Sinha, Douglas R. Adkins, Bruce H. Haughey, and Wade L. Thorstad, MD., declare that they have no conflict of interest.

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110-6311, USA

    Hiram A. Gay, Christopher R. Spencer, Daniel J. Ferraro & Wade L. Thorstad

  2. Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA

    Jingxia Liu

  3. Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA

    James S. Lewis Jr.

  4. Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, USA

    James S. Lewis Jr., Jason Diaz, Brian Nussenbaum, Jay F. Piccirillo, Parul Sinha & Bruce H. Haughey

  5. Medical Oncology, Washington University School of Medicine, St Louis, MO, USA

    Tanya Wildes & Douglas R. Adkins

Authors
  1. Hiram A. Gay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingxia Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher R. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James S. Lewis Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brian Nussenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jay F. Piccirillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel J. Ferraro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tanya Wildes
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Parul Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Douglas R. Adkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bruce H. Haughey
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Wade L. Thorstad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiram A. Gay.

Additional information

Hiram A. Gay and Jingxia Liu contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gay, H.A., Liu, J., Spencer, C.R. et al. Outcomes of P16 positive oropharyngeal squamous cell carcinoma treated with surgery and adjuvant IMRT. J Radiat Oncol 4, 37–46 (2015). https://doi.org/10.1007/s13566-014-0170-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-014-0170-7

Keywords

Search

Navigation