Reevaluation of postoperative radiation dose in the management of human papillomavirus–positive oropharyngeal cancer

Re I. Chin, Christopher R. Spencer, Todd DeWees, Michael Y. Hwang, Pranav Patel, Parul Sinha, Hiram A. Gay, Bruce H. Haughey, Brian Nussenbaum, Douglas R. Adkins, James S. Lewis, Wade L. Thorstad

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The purpose of this study was to compare outcomes of patients with p16-positive oropharyngeal squamous cell carcinoma (SCC) treated with postoperative intensity-modulated radiotherapy (IMRT) before and after an institutional dose reduction policy effective on February 2009. Methods: Between 1998 and 2013, 175 consecutive patients with p16-positive oropharyngeal SCC with extracapsular extension (ECE) and/or close or positive margins were treated postoperatively to 66 Gy (n = 109) or 60 Gy (n = 66) in 2 Gy/fx. Results: Between the 66 and 60 Gy groups, there was no difference in tumor classification (pT4 vs pT1–T3; p =.181) and nodal classification (pN2c–N3 vs pN0–N2b; p =.704), and American Joint Committee on Cancer (AJCC) group stage (IV vs I–III; p =.473). Median follow-up was 5.9 years overall (66 Gy: 7.4 years; 60 Gy: 4.0 years). There was no difference in locoregional recurrence-free survival (2-year: 98.1% vs 98.5%; p =.421). Conclusion: This study suggests that treating p16-positive oropharyngeal SCC with ECE and/or close or positive margins with postoperative IMRT to 60 Gy may not compromise locoregional recurrence-free survival compared to 66 Gy.

Original languageEnglish (US)
Pages (from-to)1643-1649
Number of pages7
JournalHead and Neck
Volume38
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

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Oropharyngeal Neoplasms
Squamous Cell Carcinoma
Intensity-Modulated Radiotherapy
Radiation
Recurrence
Survival
Neoplasms

Keywords

  • adjuvant radiotherapy
  • human papillomavirus (HPV)
  • oropharynx
  • p16
  • survival

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Reevaluation of postoperative radiation dose in the management of human papillomavirus–positive oropharyngeal cancer. / Chin, Re I.; Spencer, Christopher R.; DeWees, Todd; Hwang, Michael Y.; Patel, Pranav; Sinha, Parul; Gay, Hiram A.; Haughey, Bruce H.; Nussenbaum, Brian; Adkins, Douglas R.; Lewis, James S.; Thorstad, Wade L.

In: Head and Neck, Vol. 38, No. 11, 01.11.2016, p. 1643-1649.

Research output: Contribution to journalArticle

Chin, RI, Spencer, CR, DeWees, T, Hwang, MY, Patel, P, Sinha, P, Gay, HA, Haughey, BH, Nussenbaum, B, Adkins, DR, Lewis, JS & Thorstad, WL 2016, 'Reevaluation of postoperative radiation dose in the management of human papillomavirus–positive oropharyngeal cancer', Head and Neck, vol. 38, no. 11, pp. 1643-1649. https://doi.org/10.1002/hed.24486
Chin, Re I. ; Spencer, Christopher R. ; DeWees, Todd ; Hwang, Michael Y. ; Patel, Pranav ; Sinha, Parul ; Gay, Hiram A. ; Haughey, Bruce H. ; Nussenbaum, Brian ; Adkins, Douglas R. ; Lewis, James S. ; Thorstad, Wade L. / Reevaluation of postoperative radiation dose in the management of human papillomavirus–positive oropharyngeal cancer. In: Head and Neck. 2016 ; Vol. 38, No. 11. pp. 1643-1649.
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AU - Chin, Re I.

AU - Spencer, Christopher R.

AU - DeWees, Todd

AU - Hwang, Michael Y.

AU - Patel, Pranav

AU - Sinha, Parul

AU - Gay, Hiram A.

AU - Haughey, Bruce H.

AU - Nussenbaum, Brian

AU - Adkins, Douglas R.

AU - Lewis, James S.

AU - Thorstad, Wade L.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: The purpose of this study was to compare outcomes of patients with p16-positive oropharyngeal squamous cell carcinoma (SCC) treated with postoperative intensity-modulated radiotherapy (IMRT) before and after an institutional dose reduction policy effective on February 2009. Methods: Between 1998 and 2013, 175 consecutive patients with p16-positive oropharyngeal SCC with extracapsular extension (ECE) and/or close or positive margins were treated postoperatively to 66 Gy (n = 109) or 60 Gy (n = 66) in 2 Gy/fx. Results: Between the 66 and 60 Gy groups, there was no difference in tumor classification (pT4 vs pT1–T3; p =.181) and nodal classification (pN2c–N3 vs pN0–N2b; p =.704), and American Joint Committee on Cancer (AJCC) group stage (IV vs I–III; p =.473). Median follow-up was 5.9 years overall (66 Gy: 7.4 years; 60 Gy: 4.0 years). There was no difference in locoregional recurrence-free survival (2-year: 98.1% vs 98.5%; p =.421). Conclusion: This study suggests that treating p16-positive oropharyngeal SCC with ECE and/or close or positive margins with postoperative IMRT to 60 Gy may not compromise locoregional recurrence-free survival compared to 66 Gy.

AB - Background: The purpose of this study was to compare outcomes of patients with p16-positive oropharyngeal squamous cell carcinoma (SCC) treated with postoperative intensity-modulated radiotherapy (IMRT) before and after an institutional dose reduction policy effective on February 2009. Methods: Between 1998 and 2013, 175 consecutive patients with p16-positive oropharyngeal SCC with extracapsular extension (ECE) and/or close or positive margins were treated postoperatively to 66 Gy (n = 109) or 60 Gy (n = 66) in 2 Gy/fx. Results: Between the 66 and 60 Gy groups, there was no difference in tumor classification (pT4 vs pT1–T3; p =.181) and nodal classification (pN2c–N3 vs pN0–N2b; p =.704), and American Joint Committee on Cancer (AJCC) group stage (IV vs I–III; p =.473). Median follow-up was 5.9 years overall (66 Gy: 7.4 years; 60 Gy: 4.0 years). There was no difference in locoregional recurrence-free survival (2-year: 98.1% vs 98.5%; p =.421). Conclusion: This study suggests that treating p16-positive oropharyngeal SCC with ECE and/or close or positive margins with postoperative IMRT to 60 Gy may not compromise locoregional recurrence-free survival compared to 66 Gy.

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