Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy

Eric J. Moore; Kathryn M. Van Abel; David M. Routman; Christine M. Lohse; Katharine A.R. Price; Michelle Neben-Wittich; Ashish V. Chintakuntlawar; Daniel L. Price; Jan L. Kasperbauer; Joaquin J. Garcia; Michael L. Hinni; Samir H. Patel; Jeffrey R. Janus; Robert L. Foote; Dan J. Ma

doi:10.1002/hed.26477

Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy

Eric J. Moore, Kathryn M. Van Abel, David M. Routman, Christine M. Lohse, Katharine A.R. Price, Michelle Neben-Wittich, Ashish V. Chintakuntlawar, Daniel L. Price, Jan L. Kasperbauer, Joaquin J. Garcia, Michael L. Hinni, Samir H. Patel, Jeffrey R. Janus, Robert L. Foote, Dan J. Ma

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). Methods: Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. Results: Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). Conclusion: Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.

Original language	English (US)
Pages (from-to)	229-237
Number of pages	9
Journal	Head and Neck
Volume	43
Issue number	1
DOIs	https://doi.org/10.1002/hed.26477
State	Published - Jan 2021

Keywords

HPV
TORS
de-escalation
oropharyngeal cancer
oropharynx
squamous cell carcinoma

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/hed.26477

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Moore, E. J., Van Abel, K. M., Routman, D. M., Lohse, C. M., Price, K. A. R., Neben-Wittich, M., Chintakuntlawar, A. V., Price, D. L., Kasperbauer, J. L., Garcia, J. J., Hinni, M. L., Patel, S. H., Janus, J. R., Foote, R. L., & Ma, D. J. (2021). Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy. Head and Neck, 43(1), 229-237. https://doi.org/10.1002/hed.26477

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title = "Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy",

abstract = "Background: Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). Methods: Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. Results: Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). Conclusion: Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.",

keywords = "HPV, TORS, de-escalation, oropharyngeal cancer, oropharynx, squamous cell carcinoma",

author = "Moore, {Eric J.} and {Van Abel}, {Kathryn M.} and Routman, {David M.} and Lohse, {Christine M.} and Price, {Katharine A.R.} and Michelle Neben-Wittich and Chintakuntlawar, {Ashish V.} and Price, {Daniel L.} and Kasperbauer, {Jan L.} and Garcia, {Joaquin J.} and Hinni, {Michael L.} and Patel, {Samir H.} and Janus, {Jeffrey R.} and Foote, {Robert L.} and Ma, {Dan J.}",

note = "Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC",

year = "2021",

month = jan,

doi = "10.1002/hed.26477",

language = "English (US)",

volume = "43",

pages = "229--237",

journal = "Head and Neck",

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TY - JOUR

T1 - Human papillomavirus oropharynx carcinoma

T2 - Aggressive de-escalation of adjuvant therapy

AU - Moore, Eric J.

AU - Van Abel, Kathryn M.

AU - Routman, David M.

AU - Lohse, Christine M.

AU - Price, Katharine A.R.

AU - Neben-Wittich, Michelle

AU - Chintakuntlawar, Ashish V.

AU - Price, Daniel L.

AU - Kasperbauer, Jan L.

AU - Garcia, Joaquin J.

AU - Hinni, Michael L.

AU - Patel, Samir H.

AU - Janus, Jeffrey R.

AU - Foote, Robert L.

AU - Ma, Dan J.

PY - 2021/1

Y1 - 2021/1

N2 - Background: Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). Methods: Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. Results: Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). Conclusion: Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.

AB - Background: Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). Methods: Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. Results: Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). Conclusion: Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.

KW - HPV

KW - TORS

KW - de-escalation

KW - oropharyngeal cancer

KW - oropharynx

KW - squamous cell carcinoma

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U2 - 10.1002/hed.26477

DO - 10.1002/hed.26477

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EP - 237

JO - Head and Neck

JF - Head and Neck

IS - 1

ER -

Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy

Abstract

Keywords

ASJC Scopus subject areas

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