Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer.

Autor: Kim DY; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea., Wu HG; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea., Kim JH; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea., Lee JH; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea., Ahn SH; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea., Chung EJ; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea., Eom KY; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea., Jung YH; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea., Jeong WJ; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea., Kwon TK; Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea., Kim S; Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea., Wee CW; Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea.
Jazyk: angličtina
Zdroj: Cancer research and treatment [Cancer Res Treat] 2022 Apr; Vol. 54 (2), pp. 406-416. Date of Electronic Publication: 2021 Jun 23.
DOI: 10.4143/crt.2021.441
Abstrakt: 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.
Databáze: MEDLINE
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