TY - JOUR
T1 - Timing of Postoperative Radiotherapy in Surgically Treated HPV-Positive Oropharyngeal Squamous Cell Carcinoma
AU - Townsend, Melanie
AU - DeWees, Todd
AU - Gross, Jennifer
AU - Daly, Mackenzie
AU - Gay, Hiram
AU - Thorstad, Wade
AU - Jackson, Ryan S.
N1 - Funding Information:
We acknowledge the Department of Radiation Oncology at Washington University in St Louis, in particular Anu Chudury, for assistance with data gathering and analysis. In addition, we acknowledge the statistical analysis contributions of Parul Sinha and Dorina Kallogjeri at Washington University in St Louis, as well as Bruce Haughey, who was the original creator of this data set.
Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2019.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Objective: Optimal timing of postoperative radiotherapy (PORT) remains understudied in human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma. Objectives are to determine if delays between surgery and radiotherapy, breaks during radiotherapy, disease, or patient factors are associated with recurrence or survival decrements in HPV-related disease. Design: Retrospective review. Setting: Academic medical center. Subjects: A total of 240 cases of HPV-positive oropharyngeal squamous cell carcinoma from 2000 to 2016. Methods: Patient and tumor characteristics (American Joint Committee on Cancer, eighth edition), delays to radiation initiation, and breaks during radiation were recorded. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. Results: RFS and OS were not significantly affected by delays to PORT >6 weeks or by treatment intervals >100 days (surgery to PORT completion). Breaks during PORT significantly imparted an OS detriment (hazard ratio [HR], 2.4; 95% CI, 1.2-4.8). Advanced-stage disease was significantly associated with reduced RFS and OS. Subgroup analysis of stage I versus stage II/III disease found that >6 weeks to PORT initiation and treatment intervals >100 days did not significantly decrease RFS or OS in either stage group. Advanced-stage disease was significantly associated with worsened OS (HR, 6.6; 95% CI, 2.3-19.1) and RFS (HR, 5.3; 95% CI, 1.5-18.4). Breaks during PORT significantly reduced RFS (HR, 3.6; 95% CI, 1.2-10.8) and OS (HR, 3.2; 95% CI, 1.2-9.0) in the stage II/III subset. Conclusion: Delays to radiotherapy initiation and prolonged treatment time did not affect recurrence or survival in HPV-related oropharyngeal disease. Locoregionally advanced disease was consistently associated with worse outcomes. Breaks during PORT may affect recurrence and survival, although larger studies are needed to confirm this finding.
AB - Objective: Optimal timing of postoperative radiotherapy (PORT) remains understudied in human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma. Objectives are to determine if delays between surgery and radiotherapy, breaks during radiotherapy, disease, or patient factors are associated with recurrence or survival decrements in HPV-related disease. Design: Retrospective review. Setting: Academic medical center. Subjects: A total of 240 cases of HPV-positive oropharyngeal squamous cell carcinoma from 2000 to 2016. Methods: Patient and tumor characteristics (American Joint Committee on Cancer, eighth edition), delays to radiation initiation, and breaks during radiation were recorded. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. Results: RFS and OS were not significantly affected by delays to PORT >6 weeks or by treatment intervals >100 days (surgery to PORT completion). Breaks during PORT significantly imparted an OS detriment (hazard ratio [HR], 2.4; 95% CI, 1.2-4.8). Advanced-stage disease was significantly associated with reduced RFS and OS. Subgroup analysis of stage I versus stage II/III disease found that >6 weeks to PORT initiation and treatment intervals >100 days did not significantly decrease RFS or OS in either stage group. Advanced-stage disease was significantly associated with worsened OS (HR, 6.6; 95% CI, 2.3-19.1) and RFS (HR, 5.3; 95% CI, 1.5-18.4). Breaks during PORT significantly reduced RFS (HR, 3.6; 95% CI, 1.2-10.8) and OS (HR, 3.2; 95% CI, 1.2-9.0) in the stage II/III subset. Conclusion: Delays to radiotherapy initiation and prolonged treatment time did not affect recurrence or survival in HPV-related oropharyngeal disease. Locoregionally advanced disease was consistently associated with worse outcomes. Breaks during PORT may affect recurrence and survival, although larger studies are needed to confirm this finding.
KW - HPV positive squamous cell carcinoma
KW - oropharynx
KW - postoperative radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85067802732&partnerID=8YFLogxK
U2 - 10.1177/0194599819847144
DO - 10.1177/0194599819847144
M3 - Review article
C2 - 31159646
AN - SCOPUS:85067802732
SN - 0194-5998
VL - 161
SP - 297
EP - 306
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 2
ER -