Skip to main content

Advertisement

SpringerLink
Log in

Triplet induction chemotherapy followed by less invasive surgery without reconstruction for human papillomavirus-associated oropharyngeal cancers: Why is it successful or unsuccessful?

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

De-escalating treatments have been focused on for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). We assessed the efficacy of a triplet induction chemotherapy (ICT) followed by surgery with or without neck dissection (ND) for locally advanced OPSCC, aiming at less invasive surgery without free-flap reconstruction and avoiding postoperative irradiation.

Methods

This was a retrospective study of 41 patients with advanced resectable HPV-positive OPSCC who underwent ICT followed by surgery of primary resection with or without ND. Patients underwent triplet ICT, including docetaxel, cisplatin, and 5-fluorouracil, or carboplatin, paclitaxel, and cetuximab.

Results

Twenty-nine patients had tonsillar cancer, 15 patients were current smokers, and 18 and 12 patients had T2N1M0 and T1N1M0 status (UICC 8th), respectively. After ICT, a surgical procedure without free-flap reconstruction and tracheostomy was possible in 90.2%. Pathological complete response at both the primary site and lymph nodes was achieved in 73.2%. Of the patients who underwent surgery, no adjuvant radiotherapy was required in 85.0%. Two patients (4.9%) experienced recurrence at regional lymph nodes, but were cured by salvage ND followed by adjuvant radiotherapy.

Conclusions

Upfront ICT using highly responsive triplet chemotherapeutic regimens may enable us to perform less invasive surgery without free-flap reconstruction and to avoid postoperative irradiation to the locoregional field through excellent postoperative pathological features.

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
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jemal A, Simard EP, Dorell C et al (2013) Annual Report to the Nation on the Status of Cancer, 1975–2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 105:175–201

    Article  Google Scholar 

  2. Ragin C, Liu JC, Jones G et al (2017) Prevalence of HPV infection in racial-ethnic subgroups of head and neck cancer patients. Carcinogenesis 38:218–229

    Article  CAS  Google Scholar 

  3. Howard J, Dwivedi RC, Masterson L et al (2018) De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. Cochrane Database Syst Rev. 12:CD012939

    PubMed  Google Scholar 

  4. Fakhry C, Westra WH, Li S et al (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 100:261–269

    Article  CAS  Google Scholar 

  5. Licitra L, Perrone F, Bossi P et al (2006) High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. J Clin Oncol 24(36):5630–5636

    Article  CAS  Google Scholar 

  6. Nichols AC, Theurer J, Prisman E et al (2019) Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol 20:1349–1359

    Article  CAS  Google Scholar 

  7. Chen AM, Felix C, Wang PC et al (2017) Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study. Lancet Oncol 18:803–811

    Article  Google Scholar 

  8. Marur S, Li S, Cmelak AJ et al (2017) 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. J Clin Oncol 35(5):490–497

    Article  CAS  Google Scholar 

  9. Seiwert TY, Foster CC, Blair EA et al (2019) OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 30:297–302

    Article  CAS  Google Scholar 

  10. Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098

    Article  CAS  Google Scholar 

  11. Forastiere AA, Zhang Q, Weber RS et al (2013) Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 31:845–852

    Article  CAS  Google Scholar 

  12. Garden AS, Harris J, Trotti A et al (2008) Long-term results of concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: a phase II trial of the radiation therapy oncology group (RTOG 99-14). Int J Radiat Oncol Biol Phys 71:1351–1355

    Article  Google Scholar 

  13. Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589

    Article  CAS  Google Scholar 

  14. Yokota T, Onitsuka T, Kusafuka K et al (2014) Is postoperative adjuvant chemoradiotherapy necessary for high-risk oropharyngeal squamous cell carcinoma? Int J Clin Oncol 19:38–44

    Article  CAS  Google Scholar 

  15. Park YM, Kim HR, Cho BC et al (2017) Transoral robotic surgery-based therapy in patients with stage III–IV oropharyngeal squamous cell carcinoma. Oral Oncol 75:16–21

    Article  Google Scholar 

  16. Amin JD, Kallen ME, Hatten KM (2020) Radical tonsillectomy and superior pharyngeal constrictor anatomy: a cadaveric and oncologic specimen assessment. ORL J Otorhinolaryngol Relat Spec 82:1–9

    Article  Google Scholar 

  17. Posner MR, Hershock DM, Blajman CR et al (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357:1705–1715

    Article  CAS  Google Scholar 

  18. Vermorken JB, Remenar E, van Herpen C et al (2007) Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357:1695–1704

    Article  CAS  Google Scholar 

  19. Shirasu H, Yokota T, Kawakami T et al (2020) Efficacy and feasibility of induction chemotherapy with paclitaxel, carboplatin and cetuximab for locally advanced unresectable head and neck cancer patients ineligible for combination treatment with docetaxel, cisplatin, and 5-fluorouracil. Int J Clin Oncol 25:1914–1920

    Article  CAS  Google Scholar 

  20. Burke MS, Loree JT, Popat SR et al (2020) Presurgical induction chemotherapy for squamous cell carcinoma of the tonsil. Laryngoscope 130:1206–1211

    Article  Google Scholar 

  21. Inhestern J, Schmalenberg H, Dietz A et al (2017) A two-arm multicenter phase II trial of one cycle chemoselection split-dose docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy before two cycles of split TPF followed by curative surgery combined with postoperative radiotherapy in patients with locally advanced oral and oropharyngeal squamous cell cancer (TISOC-1). Ann Oncol 28:1917–1922

    Article  CAS  Google Scholar 

  22. Sadeghi N, Khalife S, Mascarella MA et al (2020) Pathologic response to neoadjuvant chemotherapy in HPV-associated oropharynx cancer. Head Neck 42:417–425

    Article  Google Scholar 

  23. Sadeghi N, Li NW, Taheri MR et al (2016) Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: a feasible novel approach. Head Neck 38:1837–1846

    Article  Google Scholar 

  24. Saito Y, Hayashi R, Iida Y et al (2020) Optimization of therapeutic strategy for p16-positive oropharyngeal squamous cell carcinoma: Multi-institutional observational study based on the national Head and Neck Cancer Registry of Japan. Cancer. https://doi.org/10.1002/cncr.33062 (Epub ahead of print)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Tomoya Yokota & Satoshi Hamauchi

  2. Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Tetsuro Onitsuka, Yoshiyuki Iida, Tomoyuki Kamijo, Takashi Mukaigawa, Shinichi Okada, Yuki Irifune & Kotaro Ishida

  3. Division of Medical Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hiromichi Shirasu & Yusuke Onozawa

  4. Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hirofumi Ogawa & Tsuyoshi Onoe

Authors
  1. Tomoya Yokota
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuro Onitsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satoshi Hamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiromichi Shirasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Onozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshiyuki Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomoyuki Kamijo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takashi Mukaigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinichi Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuki Irifune
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kotaro Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hirofumi Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tsuyoshi Onoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomoya Yokota.

Ethics declarations

Conflict of interest

No author has any conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yokota, T., Onitsuka, T., Hamauchi, S. et al. Triplet induction chemotherapy followed by less invasive surgery without reconstruction for human papillomavirus-associated oropharyngeal cancers: Why is it successful or unsuccessful?. Int J Clin Oncol 26, 1039–1048 (2021). https://doi.org/10.1007/s10147-021-01894-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-021-01894-z

Keywords

Search

Navigation