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 Lee Hinni, Samir H Patel, Jeffrey R. Janus, Robert Foote, Daniel J Ma

Research output: Contribution to journalArticlepeer-review

1 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 languageEnglish (US)
Pages (from-to)229-237
Number of pages9
JournalHead and Neck
Volume43
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • de-escalation
  • HPV
  • oropharyngeal cancer
  • oropharynx
  • squamous cell carcinoma
  • TORS

ASJC Scopus subject areas

  • Otorhinolaryngology

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