Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma

SIMPLE SUMMARY: Due to the overall favorable prognosis for p16+ oropharyngeal squamous cell carcinoma (OPSCC), de-escalation protocols are being implemented at a higher rate. However, there remains uncertainty regarding the best candidates for de-escalation therapy. Currently, tumor stage, p16 status, and history of smoking are widely accepted as influencing prognosis in OPSCC. Tumor and lymph node growth rates could potentially add to this growing list of prognosticators. Thus far, there is scant literature that defines tumor and nodal growth rate in OPSCC. In this study, we utilize radiation oncology software and interval CT scans to both define these rates and analyze their prognostic value. This analysis may offer a more comprehensive understanding of the natural course of OPSCC growth and aid head and neck surgeons, medical oncologists, and radiation oncologists in risk stratification. ABSTRACT: Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012–2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.