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Primary surgery results in no survival benefit compared to primary radiation for oropharyngeal cancer patients stratified by high-risk human papilloma virus status

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Abstract

We changed the primary oropharynx squamous cell carcinoma (OPSCC) treatment recommendation from primary radiation therapy (RT) to tumor surgery and neck dissection, followed by RT around the year 2000 with apparently improved survival. However, high-risk human papilloma virus (hr-HPV)-16-caused OPSCCs have increased during this period. Furthermore, hr-HPV+ OPSCC carry a better prognosis than hr-HPV-negative patients. We have, therefore, evaluated the 5-year survival in the period from 1992 to 1999 versus 2000 to 2008 stratified by hr-HPV tumor infection status. Ninety-six OPSCC patients were treated from 1992 to 1999 compared with 136 patients from 2000 to 2008. The 5-year disease-specific survival (DDS) and overall survival (OS) were recorded, while the health-related quality of life (HRQoL) scores were obtained from some of the cured patients. Thirty-eight (40 %) in the first period and 86 OPSCCs (63 %) in the second period were hr-HPV+. In the first period, 16 versus 62 patients in the last period were treated by neck dissection, primary tumor surgery, and RT. DSS among all the hr-HPV-negative patients in the first period was 51 versus 55 % in the second period, and the corresponding OS was 33 versus 31 %, respectively. The DSS among all the hr-HPV+ patients was 78 % in the first period versus 77 % in the second period, while the OS was 71 versus 69 %, respectively. The HRQoL scores among successfully treated patients were worse following surgery, plus RT than RT only. The hr-HPV-adjusted 5-year survival in OPSCC patients was similar between the two time periods. A decreased HRQoL was associated with surgical therapy, which indicates that hr-HPV+ OPSCC patients may be treated by primary RT followed by major surgery only if RT treatment fails.

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Acknowledgments

This work was supported by The Norwegian Cancer Society.

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Authors and Affiliations

  1. Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway

    Stein Lybak, Borghild Ljøkjel, Hilde Haave & Hans Jørgen Aarstad

  2. Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

    Stein Lybak, Olav K. Vintermyr & Hans Jørgen Aarstad

  3. Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway

    Àsa Karlsdottir

  4. Department of Pathology, Haukeland University Hospital, Bergen, Norway

    Olav K. Vintermyr

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  1. Stein Lybak
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Correspondence to Hans Jørgen Aarstad.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lybak, S., Ljøkjel, B., Haave, H. et al. Primary surgery results in no survival benefit compared to primary radiation for oropharyngeal cancer patients stratified by high-risk human papilloma virus status. Eur Arch Otorhinolaryngol 274, 477–487 (2017). https://doi.org/10.1007/s00405-016-4203-2

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  • DOI: https://doi.org/10.1007/s00405-016-4203-2

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