ABSTRACT
BACKGROUND: There are limited data on the prognostic significance of human papillomavirus (HPV) status in relation to traditional risk factors for head and neck squamous-cell carcinoma (HNSCC) in the postoperative setting. OBJECTIVE: To clarify the impact of HPV status on the risk for HNSCC in the postoperative setting. METHODS: We retrospectively evaluated an institutional cohort of 128 patients with HNSCC patients who had been treated with definitive surgery with or without adjuvant radiotherapy or chemoradiotherapy. Patient, disease, and treatment factors were analyzed as potential prognostic indicators. RESULTS: Lymph node extracapsular extension (ECE), perineural invasion (PNI), and lymphovascular space invasion (LVSI) positivity predicted poorer locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). Positive margins related to poorer DFS and OS. HPV status alone did not predict LRC, DFS, or OS. Compared with patients who were HPV-positive and ECE-negative, both HPV-positive and HPV-negative patients with ECE experienced significantly poorer OS (78.6%, 60%, and 43.7%, respectively; ð = .010 and ð = .018, respectively). LIMITATIONS: Retrospective, single-institution study; small patient cohort; short follow-up time. CONCLUSION: The influence of HPV in postoperative HNSCC seems limited compared with traditional risk factors such as ECE, LVSI, and PNI. De-escalation of postoperative treatment based on HPV status alone should be approached with caution.
ABSTRACT
Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical. We present a case of bulky leptomeningeal relapse of breast cancer in the setting of prior whole brain radiation therapy. In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy. This is the first report of this treatment approach for leptomeningeal relapse of breast cancer. The patient had an excellent response to treatment and durable intracranial control.
ABSTRACT
OBJECTIVES: Medically inoperable lung cancer patients often have comorbidities that preclude pathologic diagnosis from being attained. We perform a multi-institutional analysis to determine if unbiopsied early-stage lung carcinoma can be safely and effectively treated with stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: Thirty-four patients with unbiopsied lung cancer were treated with SBRT at the University of Louisville or University of Virginia. Patients had computed tomography (CT) and positron emission tomography (PET) imaging clinically consistent with lung malignancy. Median SBRT dose was 50 Gy (range, 30 to 55 Gy) in a median of 5 fractions (range, 3 to 10 fractions) with static field SBRT or volumetric modulated arc therapy. RESULTS: Median follow-up is 16.7 months. Primary tumors had a median longest dimension on the original CT of 1.6 cm (range, 0.5 to 3.3 cm) and posttreatment CT scan of 1.25 cm (range, 0.0 to 4.5 cm) (P=0.025). Median pretreatment standard uptake value on initial PET scan is 4.6 mg/mL (range, 0.0 to 16.2 mg/mL), and at a median of 7.6 months after SBRT, decreased to 2.25 mg/mL (range, 0.0 to 10.9 mg/mL) on posttreatment PET (P=0.002). Crude local control is 97.1%. The estimated 2-year regional control is 80%, distant control 85%, and overall survival 85%. There were no grade 3 or greater acute toxicities and only 3 grade 3 chronic treatment-related toxicitities. DISCUSSION: In medically inoperable patients with unbiopsied lung cancer, local control can be achieved with minimal toxicity with the use of SBRT. The use of SBRT for unbiopsied early-stage lung cancer patients should be performed in a multidisciplinary setting and after detailed discussion with the patient about the risks and benefits of SBRT.