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Definitive radiochemotherapy or initial surgery for oropharyngeal cancer

To what extent can p16 expression be used in the decision process?

Definitive Radiochemotherapie oder initiale Operation beim Oropharynxkarzinom

In welchem Umfang kann die p16-Expression im Entscheidungsprozess verwendet werden?

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Abstract

Background

The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown.

Results

Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3‑year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002.

Conclusion

Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.

Zusammenfassung

Hintergrund

In der Erstlinie werden die radio(chemo)therapeutische und die chirurgische Strategie z. B. Operation ± adjuvante Radio(chemo)therapie (RCT) für die oropharyngeale Krebsbehandlung stark diskutiert. Humane-Papillomvirus(HPV)-induzierte Tumore sind eine eigenständige Entität, die mit einer p16-Überexpression assoziiert ist, die einen wichtigen prognostischen Faktor darstellt, deren prädiktive Bedeutung jedoch unbekannt bleibt.

Ergebnisse

Unter unseren 183 konsekutiven nichtselektionierten Patienten, die zwischen 2009 und 2013 mit Resektion mit adjuvanter Therapie oder moderner definitiver RCT einschließlich intensitätsmodulierter Strahlentherapie (IMRT) behandelt wurden, beträgt das krankheitsfreie 3‑Jahres-Überleben (DFS) jeweils 74 vs. 57 % (p = 0,007). Bei der Fokussierung auf Patienten mit p16+ (49 %) ergab der chirurgische vs. radiotherapeutische Ansatz eine ähnliche Tumorkontrollrate (3-Jahres-DFS 83 vs. 82 %; p = 0,48), jedoch führte die Resektion gefolgt von adjuvanter Therapie zu einer signifikant höheren Rate an verzögerter schwerer Dysphagie (35 vs. 4 %; p = 0,0002).

Schlussfolgerung

Unsere Resultate heben die unterschiedlichen Ergebnisse nach definitiver RCT oder initialer chirurgischer Behandlung gemäß p16-Status hervor, die im Entscheidungsprozess berücksichtigt werden sollten.

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Author information

Authors and Affiliations

  1. Radiation Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France

    Anouchka Modesto M.D., Anne Laprie M.D., Ph.D., Pierre Graff M.D., Ph.D. & Michel Rives M.D.

  2. Pathology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France

    Thibaut Galissier M.D. & Emmanuelle Uro-Coste M.D., Ph.D.

  3. Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France

    Amélie Lusque

  4. Medical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France

    Jean-Pierre Delord M.D., Ph.D.

  5. Head and Neck Surgery Department, Centre Hospitalo-Universitaire de Larrey, Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Cedex 9, 31059, Toulouse, France

    Jérôme Sarini M.D. & Sébastien Vergez M.D., Ph.D.

  6. Head and Neck Surgery Department, Clinique Ambroise Paré, Toulouse, France

    Frédéric Mouchet M.D.

  7. Maxillo-facial Surgery Department, CHU Toulouse Purpan, 1 place Baylac, Toulouse, France

    Raphaël Lopez M.D., Ph.D.

Authors
  1. Anouchka Modesto M.D.
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  2. Thibaut Galissier M.D.
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  3. Amélie Lusque
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  5. Emmanuelle Uro-Coste M.D., Ph.D.
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  6. Jérôme Sarini M.D.
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  7. Frédéric Mouchet M.D.
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  8. Raphaël Lopez M.D., Ph.D.
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  9. Anne Laprie M.D., Ph.D.
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  10. Pierre Graff M.D., Ph.D.
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  11. Sébastien Vergez M.D., Ph.D.
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  12. Michel Rives M.D.
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Corresponding author

Correspondence to Anouchka Modesto M.D..

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Conflict of interest

A. Modesto, T. Galissier, A. Lusque, J.-P. Delord, E. Uro-Coste, J. Sarini, F. Mouchet, R. Lopez, A. Laprie, P. Graff, S. Vergez and M. Rives declare that they have no competing interests.

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S. Vergez and M. Rives are co last authors.

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Modesto, A., Galissier, T., Lusque, A. et al. Definitive radiochemotherapy or initial surgery for oropharyngeal cancer. Strahlenther Onkol 195, 496–503 (2019). https://doi.org/10.1007/s00066-019-01451-8

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  • DOI: https://doi.org/10.1007/s00066-019-01451-8

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