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Anticancer Research Feb 2017To evaluate the impact of race on disease stage at diagnosis in patients with oropharyngeal cancer.
AIM
To evaluate the impact of race on disease stage at diagnosis in patients with oropharyngeal cancer.
PATIENTS AND METHODS
The cohort included 18,791 adult patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, from the Surveillance, Epidemiology, and End Results 18 Database.
RESULTS
After adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with increased risk of presenting with Stage III or IV disease (OR 1.24, p=0.016), T3 or T4 tumors (OR 2.16, <0.001), distant metastasis (OR 2, p<0.001), and unresectable tumors (OR 1.65, p<0.001). Race was not associated with risk of presenting with nodal metastasis diagnosis (OR 0.93, p=0.241).
CONCLUSION
Black race is associated with increased risk of advanced disease presentation in oropharyngeal cancer.
Topics: Black or African American; Aged; Carcinoma, Squamous Cell; Cohort Studies; Female; Health Status Disparities; Humans; Lymphatic Metastasis; Male; Marital Status; Middle Aged; Multivariate Analysis; Neoplasm Staging; Oropharyngeal Neoplasms; Risk Factors; SEER Program; United States; White People
PubMed: 28179339
DOI: 10.21873/anticanres.11386 -
Cancer Radiotherapie : Journal de La... Oct 2022The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM... (Review)
Review
The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years.
Topics: Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis
PubMed: 36030192
DOI: 10.1016/j.canrad.2022.06.018 -
JAMA Network Open Jun 2021Definitive chemoradiotherapy and upfront surgical treatment are both accepted as the standard of care for advanced-stage oropharyngeal squamous cell carcinoma. However,...
IMPORTANCE
Definitive chemoradiotherapy and upfront surgical treatment are both accepted as the standard of care for advanced-stage oropharyngeal squamous cell carcinoma. However, the optimal primary treatment modality remains unclear.
OBJECTIVE
To evaluate the comparative effectiveness of definitive chemoradiotherapy and upfront surgical treatment for advanced-stage oropharyngeal cancer.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective comparative effectiveness analysis used data from the population-based Taiwan Cancer Registry. Included patients were diagnosed with clinical stage III or IV oropharyngeal squamous cell carcinoma from 2007 to 2015 and were identified from the registry. Patients with T4b or N3 disease were excluded. Data were analyzed from June 2019 through December 2020.
INTERVENTIONS
Definitive chemoradiotherapy or upfront surgical treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was overall survival, for which data were available through December 31, 2018. Secondary outcomes were progression-free survival, locoregional recurrence-free survival, and distant metastasis-free survival.
RESULTS
Among 1180 patients, 694 patients (58.8%) were in the definitive chemoradiotherapy group and 486 patients (41.2%) were in the upfront surgical treatment group. The median (interquartile range) follow-up was 3.62 (1.63-5.47) years, and most patients were men (1052 [89.1%] men) with a primary tumor in the tonsils (712 patients [60.3%]), moderately differentiated histology (604 patients [51.2%]), clinical N2 disease (858 patients [72.7%]), and clinical stage IVA disease (938 patients [79.5%]). The mean (SD) age was 54.59 (10.35) years. Primary treatment with an upfront surgical procedure was associated with a decreased risk of death during the study period (hazard ratio [HR], 0.81; 95% CI, 0.69-0.97; P = .02). However, when adjusted for age, subsite, histological grade, and T and N classification, upfront surgical treatment was no longer associated with an increased risk of death during the study period (HR, 0.96; 95% CI, 0.80-1.16; P = .70). Progression-free survival was worse in the group receiving upfront surgical treatment than in the group receiving chemoradiotherapy (HR, 1.64; 95% CI, 1.09-2.46; P = .02), and this difference persisted after adjusting for other factors associated with prognosis (ie, age, tumor subsite, histological grade, and T and N classification) (HR, 1.72; 95% CI, 1.12-2.66; P = .01).
CONCLUSIONS AND RELEVANCE
This study found that definitive chemoradiotherapy was associated with effectiveness that was comparable with that of upfront surgical treatment when adjusted for baseline factors associated with prognosis. These findings suggest that definitive chemoradiotherapy should be considered to avoid accumulating toxic effects associated with surgical treatment and chemoradiotherapy.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Chemotherapy, Adjuvant; Female; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Risk Factors; Taiwan; Treatment Outcome
PubMed: 34061201
DOI: 10.1001/jamanetworkopen.2021.12067 -
Head and Neck Pathology Jun 2024Mixed neuroendocrine-nonneuroendocrine (MiNEN) neoplasms in the head and neck are exceptionally rare biphasic tumors with unclear pathogenesis and an aggressive clinical... (Review)
Review
Mixed neuroendocrine-nonneuroendocrine (MiNEN) neoplasms in the head and neck are exceptionally rare biphasic tumors with unclear pathogenesis and an aggressive clinical behavior. This is the first reported case of an oropharyngeal MiNEN with the nonneuroendocrine component being an HPV-associated adenocarcinoma. The tumor arose in a 56 year-old male with history of long-term cigarette smoking and was composed of an adenocarcinoma intermixed with a small cell neuroendocrine carcinoma. P16 immunohistochemical stain and HPV16/18 in-situ hybridization were strongly and diffusely expressed in both components.
Topics: Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Carcinoma, Neuroendocrine; Adenocarcinoma; Papillomavirus Infections; Neoplasms, Complex and Mixed; Biomarkers, Tumor
PubMed: 38896312
DOI: 10.1007/s12105-024-01660-3 -
Biomedical Papers of the Medical... Dec 2023HPV16 status in oropharyngeal cancer (OPC) is an important prognostic factor. Its determination, based on immunistochemical analysis of p16 oncoprotein requires an... (Review)
Review
HPV16 status in oropharyngeal cancer (OPC) is an important prognostic factor. Its determination, based on immunistochemical analysis of p16 oncoprotein requires an invasive biopsy. Thus, alternative methods are being sought. Determining oral HPV16 status appears to be a promising alternative. However, it is not used routinely. This prompted us to perform a systematic literature review enabling us to evaluate the diagnostic and predictive ability of this approach. Thirty-four relevant studies were finally selected. For determination of HPV status in OPC, the calculated average sensitivity and specificity for oral sampling was 74% and 91%, respectively, with p16 tumour tissue marker being the gold standard. The method appears to be valuable in monitoring treatment response as well as the biological activity of the tumour, enabling early detection of persistent or relapsing carcinoma sufficiently long before its clinical and/or radiological manifestation. It can also contribute to identification of the primary tumour in cases of metastases of unknown origin. Last but not least, the screening HPV oral testing would help to identify individuals with persistent HPV oral infection who are at increased risk of development of OPC.
Topics: Humans; Papillomavirus Infections; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Carcinoma; Sensitivity and Specificity; Biomarkers, Tumor
PubMed: 37901925
DOI: 10.5507/bp.2023.040 -
Radiation Oncology (London, England) Apr 2023Local recurrence is the most common pattern of failure in head and neck cancer. It can therefore be hypothesised that some of these patients would benefit from an... (Comparative Study)
Comparative Study
BACKGROUND
Local recurrence is the most common pattern of failure in head and neck cancer. It can therefore be hypothesised that some of these patients would benefit from an intensified local treatment, such as radiation dose escalation of the primary tumour. This study compares treatment and toxicity outcomes from two different boost modalities in oropharyngeal cancer: simultaneous integrated boost (SIB) and brachytherapy boost.
METHODS
Two hundred and forty-four consecutive patients treated with > 72 Gy for oropharyngeal squamous cell carcinoma between 2011 and 2018 at our institution were retrospectively analysed. Data on side effects were collected from a local quality registry and supplemented with a review of medical records. Patients receiving a brachytherapy boost first had external beam radiotherapy consisting of 68 Gy in 2 Gy fractions to the gross tumour volume (GTV), and elective radiotherapy to the neck bilaterally. The brachytherapy boost was typically given using pulsed dose rate, 15 fractions and 0.56-0.66 Gy per fraction [total dose in EQD2 = 75.4-76.8 Gy (α/β = 10)]. The typical dose escalated radiotherapy with external beam radiotherapy only, was delivered using SIB with 74,8 Gy in 2.2 Gy fractions [EQD2 = 76.0 Gy (α/β = 10)] to the primary tumour, 68 Gy in 2 Gy fractions to GTV + 10 mm margin and elective radiotherapy to the neck bilaterally.
RESULTS
Dose escalation by SIB was given to 111 patients and brachytherapy boost to 134 patients. The most common type of cancer was base of tongue (55%), followed by tonsillar cancer (42%). The majority of patients had T3- or T4-tumours and 84% were HPV-positive. The 5-year OS was 72,4% (95% CI 66.9-78.3) and the median follow-up was 6.1 years. Comparing the two different dose escalation modalities we found no significant differences in OS or PFS and these results remained after a propensity-score matched analysis was performed. The analysis of grade ≥ 3 side effects showed no significant differences between the two different dose escalation techniques.
CONCLUSIONS
We found no significant differences in survival or grade ≥ 3 side effects comparing simultaneous integrated boost and brachytherapy boost as alternative dose escalation modalities in the treatment of oropharyngeal cancer.
Topics: Humans; Brachytherapy; Head and Neck Neoplasms; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Radiotherapy Dosage; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 37029424
DOI: 10.1186/s13014-023-02256-x -
Clinical Imaging Jan 2023To evaluate the agreement between pathological and radiological staging in oropharyngeal cancer by comparing the 7th and the 8th edition of the AJCC TNM system.
PURPOSE
To evaluate the agreement between pathological and radiological staging in oropharyngeal cancer by comparing the 7th and the 8th edition of the AJCC TNM system.
METHODS
This retrospective cohort study included 57 cases of oropharyngeal cancer with lymph node metastases staged with the 7th and 8th editions of the AJCC TNM system. Comparison between clinical and radiological features and differences in agreement rates were calculated between radiological and pathological staging for the primary tumor (T) and lymph nodes (N) in HPVpos and HPVneg cases.
RESULTS
Comparison of HPVpos and HPVneg revealed a significantly different distribution between early and advanced stages in the 8 th edition, with a relevant number of HPVpos patients redefined from advanced stages whit the 7 th ed. to early stages with 8 th ed. (p < 0.01); no significant differences were found when comparing all diagnostic methods for T and N.
CONCLUSIONS
The 8th edition of the AJCC TNM seems to lead to better pretreatment staging. For both HPVpos and HPVneg, the agreement between pretreatment radiological and pathological staging.
Topics: Humans; Neoplasm Staging; Papillomavirus Infections; Retrospective Studies; Oropharyngeal Neoplasms; Lymph Nodes; Prognosis
PubMed: 36375362
DOI: 10.1016/j.clinimag.2022.10.010 -
European Archives of... Jul 2020The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with...
PURPOSE
The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with locoregional recurrence after radiation, optimal treatment involves salvage surgery. The aim of this study is to identify factors that predict survival to ultimately improve patient selection for salvage surgery.
METHODS
Retrospective cohort study at an NCI-designated cancer center. We analyzed patients with a history of head and neck radiation who presented with persistent/recurrent or second primary disease requiring salvage oropharyngeal resection from 1998-2017 (n = 120). Patients were stratified into three classes based on time to recurrence and presence of laryngopharyngeal dysfunction. Primary outcomes were 5-year overall survival (OS) and disease specific survival (DSS).
RESULTS
Median OS was 27 months (median follow-up 20 months). Five-year OS was 47% for class I (recurrence > 2 years), 26% for class II (recurrence ≤ 2 years), and 0% for class III (recurrence ≤ 2 years and laryngopharyngeal dysfunction), (p < 0.0001). Five-year DSS showed significant differences between classes (p < 0.0001). On multivariate analysis, class remained predictive of OS (p = 0.04- < 0.001) and DSS (p = 0.04-0.001). Adjuvant radiation after salvage surgery with negative margins showed superior OS (71% vs. 28%, p = 0.01) and DSS (83% vs 37%, p = 0.02) compared to surgery alone and was a significant predictor of improved survival on multivariate analysis (HR 0.1, p = 0.04).
CONCLUSION
This study identified a subset of patients with oropharyngeal cancer recurrence within two years of initial treatment and with laryngopharyngeal dysfunction who have poor outcomes for salvage surgery.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Retrospective Studies; Salvage Therapy; Survival Rate
PubMed: 32193723
DOI: 10.1007/s00405-020-05913-z -
Oral Oncology Dec 2020The objective of this study is to evaluate locoregional and distant failure for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC)...
INTRODUCTION
The objective of this study is to evaluate locoregional and distant failure for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) using American Joint Committee on Cancer eighth edition (AJCC 8) staging.
MATERIALS AND METHODS
Retrospective cohort study of 457 patients with HPV + OPSCC, treated with platinum-based chemoradiation from 2002 to 2018, followed for a median of 4.3 years. Time to locoregional failure (TTLRF) and distant failure (TTDF) were estimated by Kaplan-Meier method. Log-rank, recursive partitioning analysis (RPA), and multivariable Cox proportional hazards were used to evaluate associated factors and stratify risk.
RESULTS
Rates of five-year locoregional control (LRC) and distant control (DC) were 92% (95% CI, 90-95%) and 89% (95% CI, 85-92%), respectively. Smoking, T4, N3, and stage III were associated with significantly worse TTLRF. RPA identified three distinct locoregional failure groups: cT1-3 and <19 pack-years vs. cT1-3 with ≥19 pack-years vs. cT4 (five-year LRC: 97% vs. 90% vs. 82%, P < .0001). The only factor associated with significantly worse TTDF was smoking status, while stage was not correlated. RPA identified two prognostic groups: former or never smokers vs. current smokers (five-year DC: 92% vs. 77%, P = .0003).
DISCUSSION
In the largest evaluation of HPV + OPSCC after platinum-based chemoradiation using AJCC 8, risk for locoregional recurrence was stratified by smoking, T category, N category, and overall stage. Risk of distant recurrence was only stratified by smoking status and not related to stage. This has implications for surveillance and clinical trial design.
Topics: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Antineoplastic Agents; Chemoradiotherapy; Ex-Smokers; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Platinum Compounds; Proportional Hazards Models; Retrospective Studies; Risk; Smokers; Smoking; Squamous Cell Carcinoma of Head and Neck
PubMed: 33038751
DOI: 10.1016/j.oraloncology.2020.105030 -
Radiographics : a Review Publication of... 2015The oral cavity and oropharynx are common locations of neoplastic lesions; neoplasms at these sites are often treated with surgery. The goal of this surgical treatment... (Review)
Review
The oral cavity and oropharynx are common locations of neoplastic lesions; neoplasms at these sites are often treated with surgery. The goal of this surgical treatment is to achieve tumor control while preserving, whenever possible, the function of local structures. The procedure used depends largely on the location and extension of the tumor and the disease stage. Follow-up evaluation of patients is done with computed tomography (CT) and magnetic resonance (MR) imaging. The ability to interpret characteristic features at CT and MR imaging is particularly important because normal anatomic structures are altered in specific patterns according to the distinct surgical technique applied. Anatomic changes resulting from the most commonly performed procedures (eg, glossectomy, pelvectomy, and mandibulectomy) will be presented with CT and MR images, multiplanar reconstructions, and schematic illustrations. Understanding of postsurgical CT and MR imaging findings is important to avoid misinterpretation and confusion. Familiarity with the typical postsurgical imaging appearance of the oral cavity and oropharynx is crucial for differentiating normal postsurgical changes from persistent or recurrent disease and for diagnosis of associated second primary malignancies. Knowledge of postsurgical findings is essential for analysis of the oral cavity and oropharynx and allows early diagnosis of tumor recurrence or typical complications after surgical reconstruction.
Topics: Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Mouth Neoplasms; Neoplasm Recurrence, Local; Neoplasm, Residual; Oropharyngeal Neoplasms; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 25969936
DOI: 10.1148/rg.2015140077