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Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer
PURPOSE: This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant t...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Cancer Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9016308/ https://www.ncbi.nlm.nih.gov/pubmed/34176249 http://dx.doi.org/10.4143/crt.2021.441 |
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author | Kim, Dong-Yun Wu, Hong-Gyun Kim, Jin Ho Lee, Joo Ho Ahn, Soon-Hyun Chung, Eun-Jae Eom, Keun-Yong Jung, Young Ho Jeong, Woo-Jin Kwon, Tack-Kyun Kim, Suzy Wee, Chan Woo |
author_facet | Kim, Dong-Yun Wu, Hong-Gyun Kim, Jin Ho Lee, Joo Ho Ahn, Soon-Hyun Chung, Eun-Jae Eom, Keun-Yong Jung, Young Ho Jeong, Woo-Jin Kwon, Tack-Kyun Kim, Suzy Wee, Chan Woo |
author_sort | Kim, Dong-Yun |
collection | PubMed |
description | PURPOSE: This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment. MATERIALS AND METHODS: This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I–II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT. RESULTS: With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding. CONCLUSION: We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I–II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment. |
format | Online Article Text |
id | pubmed-9016308 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Korean Cancer Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-90163082022-04-27 Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer Kim, Dong-Yun Wu, Hong-Gyun Kim, Jin Ho Lee, Joo Ho Ahn, Soon-Hyun Chung, Eun-Jae Eom, Keun-Yong Jung, Young Ho Jeong, Woo-Jin Kwon, Tack-Kyun Kim, Suzy Wee, Chan Woo Cancer Res Treat Original Article PURPOSE: This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment. MATERIALS AND METHODS: This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I–II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT. RESULTS: With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding. CONCLUSION: We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I–II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment. Korean Cancer Association 2022-04 2021-06-23 /pmc/articles/PMC9016308/ /pubmed/34176249 http://dx.doi.org/10.4143/crt.2021.441 Text en Copyright © 2022 by the Korean Cancer Association https://creativecommons.org/licenses/by-nc/4.0/This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Kim, Dong-Yun Wu, Hong-Gyun Kim, Jin Ho Lee, Joo Ho Ahn, Soon-Hyun Chung, Eun-Jae Eom, Keun-Yong Jung, Young Ho Jeong, Woo-Jin Kwon, Tack-Kyun Kim, Suzy Wee, Chan Woo Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title | Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title_full | Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title_fullStr | Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title_full_unstemmed | Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title_short | Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer |
title_sort | radiotherapy versus surgery in early-stage hpv-positive oropharyngeal cancer |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9016308/ https://www.ncbi.nlm.nih.gov/pubmed/34176249 http://dx.doi.org/10.4143/crt.2021.441 |
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