Adjuvant Radiation Therapy Alone for HPV Related Oropharyngeal Cancers with High Risk Features

• Published in: PloS one 2016-12, Vol.11 (12), p.e0168061
• Main Authors: Su, William, Liu, Jerry, Miles, Brett A, Genden, Eric M, Misiukiewicz, Krzysztof J, Posner, Marshall, Gupta, Vishal, Bakst, Richard L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biology and Life Sciences; Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Chemotherapy; Combined Modality Therapy; Dysphagia; Endoscopes; Female; Head & neck cancer; Health risks; Human papillomavirus; Humans; Male; Margins of Excision; Medical prognosis; Medicine; Medicine and Health Sciences; Middle Aged; Minimally invasive surgery; Oncology; Oropharyngeal cancer; Oropharyngeal Neoplasms - etiology; Oropharyngeal Neoplasms - radiotherapy; Oropharyngeal Neoplasms - therapy; Oropharyngeal Neoplasms - virology; Ostomy; Otolaryngology; Papillomaviridae; Papillomavirus Infections - complications; Pathology; Patients; Radiation; Radiation therapy; Radiotherapy; Radiotherapy, Adjuvant - methods; Risk; Risk Factors; Robotic surgery; Robotics; Studies; Surgery; Throat cancer; Toxicity; Treatment Outcome; Weight loss
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0168061

Current standard of care for oropharyngeal cancers with positive surgical margins and/or extracapsular extension is adjuvant chemoradiotherapy. It is unknown whether HPV+ oropharyngeal cancer benefits from this treatment intensification. To investigate the outcomes of HPV+ patients treated with adjuvant radiotherapy alone when chemoradiotherapy was indicated based on high risk pathological features. They were compared with high risk HPV+ patients treated with adjuvant chemoradiotherapy. All high risk HPV+ oropharyngeal cancer patients (9) who received radiotherapy alone were identified. We also identified 17 patients who received chemoradiotherapy as a comparison group. Median follow up time was 37.3 months. No local failures developed in adjuvant radiotherapy group. There was 1 distant recurrence in this cohort and 3 in CRT cohort. Regarding toxicity, 8 (47.1%) chemoradiotherapy patients had >10 lb. weight loss (p = 0.013), despite 75% of them having a percutaneous endoscopic gastrostomy tube placed. No individuals in radiotherapy group experienced a >10 lb. weight loss and none required a gastrostomy tube. This series provides preliminary evidence suggesting that the omission of concurrent chemotherapy to adjuvant radiotherapy may offer comparative local control rates with a lower toxicity profile in the setting of HPV+ patients with traditional high risk features.