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The Laryngoscope Jul 2019Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to compare financial parameters between chemoradiation and transoral robotic surgery (TORS) in this patient population.
STUDY DESIGN
Case-control study.
METHODS
In this study we identified patients with selected American Joint Committee on Cancer 7th Edition stage II to IVa OPC treated with TORS between January 2013 and December 2014. Fifteen patients who underwent TORS were stage matched with 15 patients treated with chemoradiation. Total charges and cost data for each patient were analyzed at 4-month and 1-year time points; functional and oncologic outcomes were assessed.
RESULTS
There were no significant differences in functional and oncologic outcomes. Patients undergoing TORS had a longer inpatient hospital stay, and most required a nasogastric tube for an average of 3.5 days. There were no local or regional recurrences. Across all time points, the TORS group had lower charges and costs compared to the chemoradiation group, with 14% lower costs at 1 year. In the chemoradiation group, nearly two-thirds of costs came from radiation therapy and pharmacy expenses. Chemotherapy accounted for most pharmacy costs. The costs of operating the surgical robot accounted for a about half of surgical costs.
CONCLUSIONS
Selected patients with stage II to IVa oropharyngeal carcinoma treated with TORS may incur lower costs than those treated nonsurgically. With rising healthcare spending, the financial impact of treatment might be considered for those patients eligible for treatment regimens with comparable functional and oncologic outcomes.
LEVEL OF EVIDENCE
3b Laryngoscope, 129:1604-1609, 2019.
Topics: Case-Control Studies; Chemoradiotherapy; Costs and Cost Analysis; Female; Humans; Intubation, Gastrointestinal; Length of Stay; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Robotic Surgical Procedures
PubMed: 30485445
DOI: 10.1002/lary.27544 -
Association Between Up-front Surgery and Risk of Stroke in US Veterans With Oropharyngeal Carcinoma.JAMA Otolaryngology-- Head & Neck... Aug 2022Cardiovascular events are an important cause of morbidity in patients with oropharyngeal squamous cell carcinoma (OPSCC). Radiation and chemotherapy have been associated...
IMPORTANCE
Cardiovascular events are an important cause of morbidity in patients with oropharyngeal squamous cell carcinoma (OPSCC). Radiation and chemotherapy have been associated with increased risk of stroke; up-front surgery allows the opportunity for (chemo)radiotherapy de-escalation.
OBJECTIVE
To evaluate whether up-front surgery was associated with decreased stroke risk compared to nonsurgical treatment for OPSCC.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted at the US Veterans Health Administration and examined US veterans diagnosed with nonmetastatic OPSCC from 2000 to 2020. Data cutoff was September 17, 2021, and data analysis was performed from October 2021 to February 2022.
EXPOSURES
Up-front surgical treatment or definitive (chemo)radiotherapy as captured in cancer registry.
MAIN OUTCOMES AND MEASURES
Cumulative incidence of stroke, accounting for death as a competing risk; and association between up-front surgery and stroke risk. After generating propensity scores for the probability of receiving surgical treatment and using inverse probability weighting (IPW) to construct balanced pseudo-populations, Cox regression was used to estimate a cause-specific hazard ratio (csHR) of stroke associated with surgical vs nonsurgical treatment.
RESULTS
Of 10 436 patients, median (IQR) age was 61 (56-67) years; 10 329 (99%) were male; 1319 (13%) were Black, and 7823 (75%) were White; 2717 received up-front surgery, and 7719 received nonsurgical therapy with definitive (chemo)radiotherapy. The 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.8%-13.3%) and death was 57.3% (95% CI, 56.2%-58.4%). Surgical patients who also received (chemo)radiotherapy had shorter radiation and chemotherapy courses than nonsurgical patients. After propensity score and IPW, the csHR of stroke for surgical treatment was 0.77 (95% CI, 0.66-0.91). This association was consistent across subgroups defined by age and baseline cardiovascular risk factors.
CONCLUSIONS AND RELEVANCE
In this cohort study, up-front surgical treatment was associated with a 23% reduced risk of stroke compared with definitive (chemo)radiotherapy. These findings present an important additional risk-benefit consideration to factor into treatment decisions and patient counseling and should motivate future studies to examine cardiovascular events in this high-risk population.
Topics: Aged; Carcinoma, Squamous Cell; Cardiovascular Diseases; Cohort Studies; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Stroke; Veterans
PubMed: 35737359
DOI: 10.1001/jamaoto.2022.1327 -
Journal of B.U.ON. : Official Journal... 2018Human papillomavirus (HPV)-mediated cervical carcinogenesis represents a well analyzed model of viral implication in epithelial malignant transformation. Mechanisms of...
Human papillomavirus (HPV)-mediated cervical carcinogenesis represents a well analyzed model of viral implication in epithelial malignant transformation. Mechanisms of high risk (HR) HPV-related infection seem to demonstrate a similar action regarding its implication in head and neck (HN) carcinomas, predominantly in squamous cell carcinoma (SCC) histological type. The prevalence of HR HPV subtypes - mainly HPV16 - is characterized by a broad geographic heterogeneity. Furthermore, HPV-associated HNSCCs demonstrate differences regarding sexual, molecular, epidemiological, and prognostic features compared to alcohol and tobacco dependent ones. Based on these differences, HPV-derived HNSCC appear to be a specific well-defined entity mostly affecting young to middle-aged - male mainly - non-smokers. This is a strong reason of detecting an increased HR-HPV DNA levels -due to viral transmission - in oropharyngeal and laryngeal anatomic regions. Additionally, different response rates to chemoradiation and targeted therapeutic regimens are another significant field for handling these SCC malignancies in the corresponding patients. In the current special article we explored the role of HPV-related carcinogenesis in oropharyngeal and laryngeal SCC focused on the latest molecular aspects.
Topics: Carcinoma, Squamous Cell; DNA, Viral; Head and Neck Neoplasms; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 29552754
DOI: No ID Found -
Journal of Cancer Research and... Jan 2024To retrospectively access outcome, adverse events and prognostic factors in oropharyngeal carcinoma (OPC) patients treated with intensity-modulated radiotherapy (IMRT).
BACKGROUND
To retrospectively access outcome, adverse events and prognostic factors in oropharyngeal carcinoma (OPC) patients treated with intensity-modulated radiotherapy (IMRT).
METHODS
Ninety-eight OPC patients were treated between 2000 and 2015. Thirty-three patients received definitive and 65 adjuvant radiotherapy. Seventy-one percent had simultaneous chemotherapy. Patients were systematically followed up (mean 114 months, range 19-197 months). Statistical analysis used Kaplan-Meier method, Cox regression analysis, and log-rank test. Adverse events were classified according to common toxicity criteria version (CTCAE) 4.03.
RESULTS
The 1-, 5-, and 10-year overall survival rates in the adjuvant vs. definitive cohort were 90.8% vs. 66.7%, 67.4% vs. 33.1%, and 57.7% vs. 16.5%. Survival in the adjuvant cohort was significantly longer than in the definitive cohort (P < 0.00005). Patients <65 years had a significantly longer survival than older patients. Locoregional tumor control rates after 1-, 5-, and 10 years in the adjuvant vs. definitive cohort were 90.2% vs. 66.7%, 82.2% vs 45.4%, and 72.1% vs. 30.3%. Locoregional tumor control in the adjuvant cohort was significantly longer than in the definite cohort (P < 0.005). Distant metastases were diagnosed in 20.4% of all patients. Most patients had mild CTCAE grade 1 and 2 adverse events and mild late adverse events including xerostomia, dysphagia, and lymphedema.
CONCLUSION
Intensity-modulated radiotherapy for OPC is an important part of the treatment algorithm alone and in particular after surgery while the additional benefits of chemotherapy might be age dependent. Despite advanced tumor stages, nearly half of our patients were alive in the long term. The majority of patients had relatively mild chronic adverse events.
Topics: Humans; Radiotherapy, Intensity-Modulated; Retrospective Studies; Oropharyngeal Neoplasms; Radiotherapy, Adjuvant; Carcinoma
PubMed: 38554349
DOI: 10.4103/jcrt.jcrt_2178_22 -
European Journal of Surgical Oncology :... Jul 2024Transoral Robotic Surgery (TORS) and radiotherapy are considered oncologically equivalent primary treatment options for early-stage HPV-positive oropharyngeal squamous... (Meta-Analysis)
Meta-Analysis Comparative Study
Quality of life outcomes comparing primary Transoral Robotic Surgery (TORS) with primary radiotherapy for early-stage oropharyngeal squamous cell carcinoma: A systematic review and meta-analysis.
BACKGROUND
Transoral Robotic Surgery (TORS) and radiotherapy are considered oncologically equivalent primary treatment options for early-stage HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). Quality of Life (QoL) and Patient Reported Outcome Measures (PROMs) are therefore imperative in supporting clinical decision-making and optimising patient-centred care. The aim of this article is to evaluate how these primary treatment modalities compare in terms of QoL.
MATERIALS AND METHODS
Systematic review and meta-analysis of studies comparing primary TORS and primary radiotherapy for OPSCC using validated QoL tools. Swallowing and global QoL were the primary endpoints with secondary endpoints including all other QoL domains. An inverse variance random-effects model was employed to calculate the weighted estimate of the treatment effects across trials.
RESULTS
A total of six studies collectively reporting on 555 patients were included (n = 236 TORS and n = 319 radiotherapy). Meta-analysis showed no significant difference for swallowing (mean difference = -0.24, p = 0.89) and global QoL (mean difference = 4.55, p = 0.14). For the remaining QoL domains (neck/shoulder impairment, neurotoxicity, voice, xerostomia, speech, and distress), the scarcity of data did not permit meta-analysis. However, the existing data showed no significant difference for any except for xerostomia where TORS appears favourable in the sole study reporting on this.
CONCLUSIONS
TORS and radiotherapy appear to be comparable primary treatment options for early stage OPSCC when it comes to QoL. However, a substantial proportion of patients in the TORS group received adjuvant (chemo)radiotherapy rendering it difficult to establish the 'true' QoL outcomes following surgery alone. There are also minimal studies reporting QoL outcomes beyond swallowing and global QoL. Further research is therefore needed, including more randomised trials adequately powered to detect differences in QoL outcomes.
Topics: Humans; Robotic Surgical Procedures; Quality of Life; Oropharyngeal Neoplasms; Patient Reported Outcome Measures; Neoplasm Staging; Carcinoma, Squamous Cell; Deglutition
PubMed: 38795678
DOI: 10.1016/j.ejso.2024.108434 -
The Laryngoscope Jun 2021The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on...
OBJECTIVES
The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on survival in de novo metastatic OPSCC patients who received systemic therapy.
METHODS
We queried the NCDB from 2004-2015 for metastatic OPSCC patients at diagnosis with known HPV-status who received systemic therapy. The association of head and neck radiotherapy with overall survival was analyzed using the Kaplan-Meier method, Cox proportional hazards model, and propensity score-matched analysis adjusting for demographic and disease-specific prognostic factors.
RESULTS
Of the 2,139 patients with metastatic OPSCC who presented with metastases and received systemic treatment, we identified 556 patients with known HPV-status. Among these 556 patients, 49% were HPV-positive and 56% received head and neck radiotherapy. With a median follow-up of 17.5 months (IQR 6.0-163.4 months), radiotherapy was associated with significantly improved 1-year OS (67% vs 58%, log-rank P < .001) which remained significant on MVA (HR 0.78 95% CI 0.62-0.97 P = .029). In HPV-status subgroup analysis, a survival benefit was identified in HPV-positive patients (1-year OS 77% vs 67%, log-rank P < .001) but not in HPV-negative patients. Results were consistent on a propensity score-matched analysis of 212 HPV-positive matched patients (HR 0.66, 95% CI 0.49-0.83, P < .001).
CONCLUSION
The survival of metastatic OPSCC remains limited. In this large series of patients with known HPV-status, head and neck radiotherapy was associated with longer survival in those with HPV-associated disease. These data could guide management of this challenging group of patients for head and neck cancer practitioners.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E1847-E1853, 2021.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis; Propensity Score; Survival Rate
PubMed: 33141455
DOI: 10.1002/lary.29245 -
Journal of Cancer Research and... 2015In recent years there has been change in trends in the incidence of head and neck squamous cell carcinoma (HNSCC) with oropharyngeal carcinoma (OPC) showing an increased... (Review)
Review
In recent years there has been change in trends in the incidence of head and neck squamous cell carcinoma (HNSCC) with oropharyngeal carcinoma (OPC) showing an increased incidence, attributable specifically to infection by human papillomavirus (HPV). At the same time there is change in demographic characteristics and prognosis of this subset of HNSCC. Considering the better prognosis, researchers are trying to reduce the acute and long-term toxicities by alteration of various components of treatment protocols. Although treatment deintensification is an option for this group of patients, there is no standard protocol available and should be tried only in the protocol setting.
Topics: Head and Neck Neoplasms; Humans; Incidence; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prevalence
PubMed: 25879328
DOI: 10.4103/0973-1482.151445 -
Current Opinion in Otolaryngology &... Apr 2015This article reviews literature pertaining to squamous cell carcinoma (SCC) of the oropharynx and the evolution of transoral surgical (TOS) techniques for its... (Review)
Review
PURPOSE OF REVIEW
This article reviews literature pertaining to squamous cell carcinoma (SCC) of the oropharynx and the evolution of transoral surgical (TOS) techniques for its management. Oncologists are recognizing a changing pattern in the cause of oropharyngeal cancer, namely the increasing incidence of HPV-associated tumors. An effort is underway to reduce the morbidity of treatment without jeopardizing survival. This is a timely discussion for reassessment of current standards of care and opening dialogue on treatment de-escalation. Transoral approaches including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) have revolutionized the surgical approach to SCC.
RECENT FINDINGS
The incidence of HPV-related oropharyngeal SCC is increasing at epidemic rates. Although there are no studies comparing nonsurgical treatment to TOS in a randomized controlled fashion, there is an abundance of retrospective and prospective reports of TORS and TLM. Both early and advanced-stage oropharyngeal tumors can be managed successfully with surgery, with or without adjuvant therapy.
SUMMARY
Although there are no hard scientific differences in oncologic outcomes between primary chemoradiation protocols and primary TOS-based approaches, retrospective comparisons support an advantage of primary surgery. In addition, functional outcomes may be superior following TOS treatment. Management of oropharyngeal SCC will most likely continue to be multidisciplinary with an ongoing effort to de-escalate treatment to reduce morbidity.
Topics: Carcinoma, Squamous Cell; Humans; Laser Therapy; Microsurgery; Mouth; Natural Orifice Endoscopic Surgery; Oropharyngeal Neoplasms; Robotic Surgical Procedures
PubMed: 25761152
DOI: 10.1097/MOO.0000000000000143 -
International Journal of Molecular... Nov 2022Biomarkers are crucial in oncology, from detection and monitoring to guiding management and predicting treatment outcomes. Histological assessment of tissue biopsies is... (Review)
Review
Biomarkers are crucial in oncology, from detection and monitoring to guiding management and predicting treatment outcomes. Histological assessment of tissue biopsies is currently the gold standard for oropharyngeal cancers, but is technically demanding, invasive, and expensive. This systematic review aims to review current markers that are detectable in biofluids, which offer promising non-invasive alternatives in oropharyngeal carcinomas (OPCs). A total of 174 clinical trials from the PubMed search engine in the last 5 years were identified and screened by 4 independent reviewers. From these, 38 eligible clinical trials were found and subsequently reviewed. The biomarkers involved, categorized by human papillomavirus (HPV)-status, were further divided according to molecular and cellular levels. Recent trials investigating biomarkers for both HPV-positive and HPV-negative OPCs have approaches from various levels and different biofluids including plasma, oropharyngeal swabs, and oral rinse. Promising candidates have been found to aid in detection, staging, and predicting prognosis, in addition to well-established factors including HPV-status, drinking and smoking status. These studies also emphasize the possibility of enhancing prediction results and increasing statistical significance by multivariate analyses. Liquid biopsies offer promising assistance in enhancing personalized medicine for cancer treatment, from lowering barriers towards early screening, to facilitating de-escalation of treatment. However, further research is needed, and the combination of liquid biopsies with pre-existing methods, including in vivo imaging and invasive techniques such as neck dissections, could also be explored in future trials.
Topics: Humans; Alphapapillomavirus; Papillomaviridae; Oropharyngeal Neoplasms; Biomarkers; Carcinoma
PubMed: 36430813
DOI: 10.3390/ijms232214336 -
General Dentistry 2021Human papillomavirus (HPV) has a nearly ubiquitous prevalence within the adolescent and adult populations worldwide. The virus has been implicated for decades in...
Human papillomavirus (HPV) has a nearly ubiquitous prevalence within the adolescent and adult populations worldwide. The virus has been implicated for decades in cervical and uterine cancers, but recent data have shown an increase in cases of virally related oropharyngeal squamous cell carcinoma in both male and female cohorts. The objective of this article is to review the oral health implications of HPV infection, including oral and oropharyngeal prevalence, manifestations, neoplastic potential of HPV-associated head and neck lesions, treatment modalities, and vaccine use. The article will also discuss the continuing education needs of oral healthcare providers. Dental professionals should routinely screen patients for oral and oropharyngeal manifestations of HPV infection, seek timely referral for therapeutic intervention of potentially malignant lesions, and become strong proponents of HPV vaccinations for at-risk patients.
Topics: Adolescent; Adult; Alphapapillomavirus; Carcinoma, Squamous Cell; Dentists; Female; Humans; Male; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 33661110
DOI: No ID Found