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The Impact of Surgical Resectability on Outcomes for Patients Undergoing Primary Radiation Treatment for Human Papillomavirus-Related Oropharyngeal Cancer.
Fnais, Naif; Laxague, Francisco; Alzahrani, Faisal; Fung, Kevin; Di Gravio, Eric; MacNeil, Danielle; Mendez, Adrian; Yoo, John; Lang, Pencilla; Mymryk, Joe S; Barrett, John W; Tay, Keng Yow; Leung, Andrew; Nichols, Anthony C; Palma, David A.
Afiliação
  • Fnais N; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
  • Laxague F; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Alzahrani F; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
  • Fung K; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Di Gravio E; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • MacNeil D; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Mendez A; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Yoo J; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Lang P; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
  • Mymryk JS; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada.
  • Barrett JW; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Tay KY; Department of Diagnostic Imaging, University of Western Ontario, London, Ontario, Canada.
  • Leung A; Department of Diagnostic Imaging, University of Western Ontario, London, Ontario, Canada.
  • Nichols AC; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.
  • Palma DA; Department of Oncology, University of Western Ontario, London, Ontario, Canada. Electronic address: david.palma@lhsc.on.ca.
Int J Radiat Oncol Biol Phys ; 113(3): 521-529, 2022 07 01.
Article em En | MEDLINE | ID: mdl-35227792
ABSTRACT

PURPOSE:

Primary radiation therapy with or without chemotherapy (RT/CRT) is the most common treatment for oropharyngeal squamous cell carcinomas (OPSCC), but there has been an increase in transoral surgery (TOS) for T1-2 tumors. Because only a subset of T1-2 tumors are TOS-favorable, nonrandomized comparisons between RT/CRT and TOS could be confounded by indication. We aimed to compare outcomes of potential TOS-candidates versus non-TOS candidates, among patients who underwent RT/CRT for early T-stage OPSCC. METHODS AND MATERIALS For patients treated with RT/CRT for early-stage human papilloma virus positive OPSCC between 2014 and 2018, pretreatment imaging was reviewed by 3 head and neck surgeons, blinded to outcomes, to assess primary-site appropriateness for TOS, and extracapsular extension (ECE) was scored by a head and neck neuroradiologist. We compared outcomes based on surgical favorability pertaining to (1) the primary site tumor alone and (2) the primary site and an absence of ECE. Kaplan-Meier estimates for overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared using the log-rank test, with Cox regression used for multivariable modeling.

RESULTS:

One hundred and forty-three patients were evaluated, of which 121 were male (84.6%), the median age was 59.4 years, and all of them were p16 positive (100%). The primary site was TOS-favorable in 115 of 143 (80.4%). Patients with TOS-favorable primary site experienced superior 5-year OS (89.8% vs 71.2%, P = .017), DSS (90.4% vs 63.4%, P = .022), and RFS (83% vs 49.4%, P = .04) compared with TOS-unfavorable patients. Similarly, patients with a TOS-favorable primary site and no ECE on imaging 101 of 143 (70.6%), had improved OS, DSS, and RFS (P < .05) compared with TOS-unfavorable patients.

CONCLUSIONS:

In this first study to assess surgical favorability as a prognostic factor among patients with T1/2 p16+ OPSCC, patients with TOS-favorable early-stage OPSCC have better outcomes than TOS-unfavorable patients. This provides valuable prognostic information for patients, and also suggests the risk of confounding by indication in nonrandomized comparisons of treatment modalities.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Carcinoma de Células Escamosas / Neoplasias Orofaríngeas / Alphapapillomavirus / Neoplasias de Cabeça e Pescoço Idioma: En Ano de publicação: 2022 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Carcinoma de Células Escamosas / Neoplasias Orofaríngeas / Alphapapillomavirus / Neoplasias de Cabeça e Pescoço Idioma: En Ano de publicação: 2022 Tipo de documento: Article