Outcomes of HPV-related oropharyngeal cancer patients treated by radiotherapy alone using altered fractionation

• Published in: Radiotherapy and oncology Vol. 103; no. 1; pp. 49 - 56
• Main Authors: O’Sullivan, Brian, Huang, Shao Hui, Perez-Ordonez, Bayardo, Massey, Christine, Siu, Lillian L, Weinreb, Ilan, Hope, Andrew, Kim, John, Bayley, Andrew J, Cummings, Bernard, Ringash, Jolie, Dawson, Laura A, Cho, B.C. John, Chen, Eric, Irish, Jonathan, Gilbert, Ralph W, Hui, Angela, Liu, Fei-Fei, Zhao, Helen, Waldron, John N, Xu, Wei
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.04.2012
• Subjects: Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Dose Fractionation; Female; Hematology, Oncology and Palliative Medicine; Human papillomavirus; Humans; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Oropharyngeal carcinoma; Oropharyngeal Neoplasms - etiology; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Outcome; Papillomavirus Infections - complications; Radiotherapy; Human papillomavirus; Oropharyngeal carcinoma; Radiotherapy; Chemoradiotherapy; Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2012.02.009

Abstract Purpose To report outcome of HPV-related [HPV(+)] oropharyngeal cancer (OPC) managed predominantly by altered-fractionation radiotherapy-alone (RT-alone). Methods OPCs treated with RT-alone ( n = 207) or chemoradiotherapy (CRT) ( n = 151) from 2001 to 2008 were included. Overall survival (OS), local (LC), regional (RC) and distant (DC) control were compared for HPV(+) vs. HPV-unrelated [HPV(−)], by RT-alone vs. CRT, and by smoking pack-years (⩽10 vs. >10). Multivariate analysis identified predictors. Results HPV(+) ( n = 277) had better OS (81% vs. 44%), LC (93% vs. 76%), RC (94% vs. 79%) (all p < 0.01) but similar DC (89% vs. 86%, p = 0.87) vs. HPV(−) ( n = 81). HPV(+) stage IV CRT ( n = 125) had better OS (89% vs. 70%, p < 0.01), but similar LC (93% vs. 90%, p = 0.41), RC (94% vs. 90%, p = 0.31) and DC (90% vs. 83%, p = 0.22) vs. RT-alone ( n = 96). Both HPV(+) RT-alone ( n = 37) and CRT ( n = 67) stage IV minimal smokers had favorable OS (86% vs. 88%, p = 0.45), LC (95% vs. 92%, p = 0.52), RC (97% vs. 93%, p = 0.22), and DC (92% vs. 86%, p = 0.37). RT-alone and heavy-smoking were independent predictors for lower OS but not CSS in multivariate analysis. Conclusions Overall, HPV(+) RT-alone stage IV demonstrated lower survival but comparable disease control vs. CRT, but no difference was apparent among minimal smokers.