Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases

ObjectivesHead and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group).MethodsWe reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016.ResultsAmong 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780).ConclusionA survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.     

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypopharyngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment. The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology. All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathology, 6) presenting symptoms, 7) time to diagnosis, 8) patients' general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases. Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.     

Lokal fortgeschrittene Nasopharynxkarzinome

Background

The excellent results yielded by hyperfractionated and accelerated radiotherapy associated with concurrent chemotherapy in locally advanced oropharyngeal and hypopharyngeal carcinomas led to investigation of this therapeutic regimen in nasopharyngeal carcinomas also.

Methods

Thirty-five patients with stage III and IV nasopharyngeal carcinomas received accelerated hyperfractionated radiotherapy with concurrent chemotherapy (5-FU, mitomycin C + leucovorin). In the first 3 weeks of treatment five 2-Gy doses per week were delivered to the primary tumour and regional lymph nodes. The fractionation was then accelerated, with 1.4 Gy given twice daily until a total dose of 72 Gy had been administered.

Results

The overall objective response rate was 100%. The median follow-up period was 71 months. Salvage surgery of the lymph nodes was performed in 10 patients, revealing vital tumour tissue in 6 of these. The actuarial 5-year local control rate was 64% (95%CI: 47–81%), while overall actuarial survival at 5 years was 70% (95%CI: 53–86%).

Conclusion

Hyperfractionated accelerated radiotherapy with concurrent chemotherapy is effective and feasible in locally advanced nasopharyngeal carcinoma.     

Age-adjusted Charlson Comorbidity Index predicts prognosis of laryngopharyngeal cancer treated with radiation therapy

Objectives: To examine the ability of comorbidity indices to predict the prognosis of laryngopharyngeal cancer and their association with treatment modalities.

Methods: This retrospective study included 198 patients with laryngeal, hypopharyngeal, and oropharyngeal cancers. The effect of comorbidity indices on overall survival between surgery and (chemo)-radiation therapy ((C)RT) groups was analyzed. The cumulative incidence rates for cancer mortality and other mortalities according to the age-adjusted Charlson Comorbidity Index (ACCI) and Charlson Comorbidity Index (CCI) were compared.

Results: Univariate survival analyses showed a significant association between the ACCI and overall survival in the (C)RT group, but not in the surgery group. The association between the CCI and overall survival was not significant in either group. In multivariate analyses, a high ACCI score was an independent prognostic factor in the (C)RT group (HR 2.89, 95% confidence interval (CI) 1.28–6.49), but not in the surgery group (HR 1.39, 95%CI 0.27–5.43). The higher ACCI group had increased mortality from other causes compared with the lower ACCI group (5-year cumulative incidence, 8.5% and 17.8%, respectively, p?=?.003).

Conclusion: The ACCI was a better prognostic factor than the CCI. Surgery may be more beneficial than radiation for patients with a high ACCI.     

Conservation surgery for laryngeal and hypopharyngeal cancer

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.     

T4b期下咽癌非手术综合治疗77例回顾性分析

目的:分析非手术综合治疗T4b期下咽癌的有效性、安全性及影响临床预后的因素。方法:回顾性分析2010年1月至2021年6月解放军总医院耳鼻咽喉头颈外科医学部收治的77例下咽癌T4b期患者的临床资料,均为男性,年龄（57.0±8.0）岁。治疗方式均采用诱导化疗+同步放化疗,总结该组患者的治疗完成率和不良反应,并利用Kap...     

Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database

BackgroundGiven the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates.MethodsOur analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES.Results15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58–0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64–0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63–0.91] and HR 0.84 95% CI [0.74–0.96], respectively). We found no significant survival association based on income level.ConclusionIn this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.     

Free flap reconstructions in the management of oral and pharyngeal cancer.

Fifty patients who had undergone microvascular free flap reconstruction of the oral cavity or pharynx for malignancy between 1989 and 1995 were retrospectively analysed to find factors predicting postoperative complications and outcomes. The mean follow-up time was 2.6 years. More than half (26/50) of the patients had a stage IV malignancy and 10 patients had a recurrent tumour. The overall flap success rate, with 2 flap losses, was 96%. Postoperative medical complications occurred in 29/50 (58%) cases. The recipient site of 10/50 (20%) flaps required re-exploration. Mortality was 2%, with 1 death occurring within 30 days. The mean survival rate after the microvascular operation was 1.6 years, and the 3- and 5-year survival rates were 42% and 23%, respectively. Patients with an oropharyngeal tumour seemed to have the best prognosis and those with a hypopharyngeal tumour the poorest. Men had a threefold greater risk of dying within < 1 year postoperatively compared with women. Tumour stage was the strongest attribute influencing survival. The risk of death after the microvascular procedure increased 2.8-fold when the stage advanced from II to III or from II to IV. None of the tested variables alone could predict complications.     

Free Flap Reconstructions in the Management of Oral and Pharyngeal Cancer

Fifty patients who had undergone microvascular free flap reconstruction of the oral cavity or pharynx for malignancy between 1989 and 1995 were retrospectively analysed to find factors predicting postoperative complications and outcomes. The mean follow-up time was 2.6 years. More than half (26/50) of the patients had a stage IV malignancy and 10 patients had a recurrent tumour. The overall flap success rate, with 2 flap losses, was 96%. Postoperative medical complications occurred in 29/50 (58%) cases. The recipient site of 10/50 (20%) flaps required re-exploration. Mortality was 2%, with 1 death occurring within 30 days. The mean survival rate after the microvascular operation was 1.6 years, and the 3- and 5-year survival rates were 42% and 23%, respectively. Patients with an oropharyngeal tumour seemed to have the best prognosis and those with a hypopharyngeal tumour the poorest. Men had a threefold greater risk of dying within &lt;1 year postoperatively compared with women. Tumour stage was the strongest attribute influencing survival. The risk of death after the microvascular procedure increased 2.8-fold when the stage advanced from II to III or from III to IV. None of the tested variables alone could predict complications.     

Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer

Abstract

Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy.

Material and methods: 170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery.

Results: Median survival time was 30 months (range: 3–59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6–32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5–49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p?=?.237), however patients with a partial response had a significant decrease in survival (32.2%) (p?<?.001).

Conclusions: In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.     

Retropharyngeal node dissection during total pharyngolaryngectomy for hypopharyngeal cancer

To clarify the efficacy of retropharyngeal (RP) node dissection for hypopharyngeal cancer (HPC). From 1990 to 1997 (Period I), we examined the RP area preoperatively using computed tomography (CT) and magnetic resonance imaging (MRI), and dissected this region during total pharyngolaryngectomy (TPL) when lymph node shadows were identified. From 1998 to 2001 (Period II), we dissected this region during TPL for all patients displaying stage IV HPC or invasion of the oropharyngeal wall. Outcomes were investigated for patients with positive RP nodes identified during TPL or postoperatively. From 1990 to 2001, positive RP nodes were identified in 41 patients during TPL and in 13 patients, postoperatively. These 54 patients represented 14.8% of all patients with HPC in our hospital. Tumors of the pyriform sinus with oropharyngeal invasion and tumors of the posterior wall both displayed high risk of positive RP nodes. Frequencies of RP nodes were: stage I, 3.0%; stage II, 10.3%; stage III, 9.8%; stage IV, 19.2%. Although preoperative imaging revealed positive RP nodes for 32 patients, positive nodes were too small nodes to detect on CT or MRI in nine patients. No significant differences in survival were noted between Periods I and II. However, 11 of the 41 patients with positive RP nodes during TPL survived >2 years without disease, while only one of the 13 patients with positive RP nodes, identified postoperatively, survived >2 years. Patients with positive RP nodes displayed poor local control rate. RP dissection did not improve survival rate.     

Intensification regimen for advanced-stage resectable hypopharyngeal carcinoma

OBJECTIVE: To determine feasibility, compliance, long-term survival, and disease control rates in the intensification regimen for advanced resectable hypopharyngeal carcinoma. DESIGN: Prospective, nonrandomized, controlled phase 2 trial with a median follow-up period of 89 months (range, 3.4-140.0 months). SETTING: Cancer center at a state university. PATIENTS: Thirty-two patients (age range, 44-79 years; median age, 59 years) with advanced (69% stage IV, 31% stage III) resectable hypopharyngeal carcinoma. INTERVENTIONS: Combination of surgery, radiation therapy, and chemotherapy (cisplatin and paclitaxel) along with intraoperative radiation therapy. MAIN OUTCOME MEASURES: Compliance, long-term survival, and locoregional and systemic disease control rates and functional outcome. RESULTS: The protocol compliance rate was 62% (20 of 32 patients), and the overall 5-year survival rate was 56%. Local recurrence occurred in 3 patients (9%). The systemic disease control rate was 91% (29 of 32 patients). Total laryngectomy was required in 15 patients (47%); preservation of the larynx was possible in 17 patients (53%). Only 3 (13%) of 6 patients were percutaneous endoscopic gastrostomy tube dependent in the long-term follow-up. CONCLUSIONS: The intensification regimen described in this study accomplished excellent long-term survival and disease control rates in patients with advanced resectable hypopharyngeal carcinoma. The future plan is to proceed with a phase 3 trial if the single-institutional experience at The Ohio State University can be duplicated in a multi-institutional phase 2 study.     

303例下咽癌的外科治疗及组织移植修复重建术的临床分析

目的探讨下咽癌的外科治疗及术后下咽食管缺损不同组织移植Ⅰ期重建方法在下咽癌治疗中的远期疗效。方法回顾性分析1965～1998年外科治疗下咽癌患者303例，其中130例经不同组织移植重建下咽食管手术治疗(1997年UICC分期：Ⅱ期5例；Ⅲ期16例；Ⅳ期109例)，其中梨状窝区94例，咽后壁区18例，环后区18例。游离空肠15例，胃代下咽食管81例，结肠代下咽食管10例，胸大肌肌皮瓣修复20例，其他方法4例。173例下咽癌患者不需要重建(Ⅰ期7例，Ⅱ期12例，Ⅲ期51例，Ⅳ期103例)，其中梨状窝160例，咽后壁8例，环后5例。结果Kaplan-Meire法统计生存率，130例组织移植重建患者3年生存率为43．2％，5年生存率为36．4％；173例不需要组织重建患者3年生存率为59．2％，5年生存率为47．7％。各组吞咽功能良好率均在80％，以上。胃代下咽食管手术死亡率为8．6％(7／81例)；胸大肌肌皮瓣修复手术死亡率15．0％，(3／209例)；游离空肠及结肠代食管下咽无手术死亡。总手术并发症20世纪90年代之前为44．3％(35／79例)，90年代手术并发症为13．7％(7／51例)，x^2=13．457，P=0．004，差异有显著性；其中90年代胸大肌肌皮瓣修复并发症最高为18．2％(2／11例)。结论游离空肠、胃代下咽食管、胸大肌肌皮瓣修复在下咽癌的生存率、吞咽功能的恢复及手术并发症等方面均取得较好的治疗效果，是值得提倡的重建方法。     

Racial disparities in Human Papillomavirus (HPV) associated head and neck cancer

Purpose

Poorer survival from head and neck squamous cell carcinoma (HNSCC) in African Americans (AA) may be due to disparity in the prevalence of Human Papillomavirus (HPV) but earlier studies often failed to control other etiological factors. We aimed to elucidate whether racial disparities in HPV prevalence and overall survival were due to confounding from smoking or alcohol use.

Materials and methods

385 patients with SCC of the mouth, pharynx, nose, or larynx who had surgical resection at Wayne State University affiliated hospitals were identified through a population-based cancer registry. Formalin fixed paraffin embedded tissue blocks were used to determine the presence of HPV DNA and its genotype using a sensitive broad-spectrum PCR technique. Patients’ demographics, tumor characteristics and vital status were obtained through record linkage with the registry data and smoking and alcohol information was abstracted from medical record. Cox’s proportional hazard model and unconditional logistic regression models were employed to analyze the overall survival and tumor HPV-positivity, respectively.

Results

HPV positivity in oropharyngeal cancer was substantially lower in AA than in other racial groups (odds ratio 0.14, 95% confidence interval (CI) 0.05–0.37) and adjustment for smoking or alcohol did not change this association. However, a significantly increased hazard ratio of death in AA oropharyngeal cancer patients (univariable hazard ratio (HR) 2.55, 95% CI 1.42–4.59) decreased to almost unity (HR 1.49, 95% CI 0.75–2.93) after adjustment for HPV and smoking.

Conclusions

Lower HPV prevalence in AA largely accounts for their poorer survival from oropharyngeal cancer, but not other HNSSC.     

下咽癌共病食管癌的高危因素及预后分析

目的 探讨下咽癌共病同时性食管癌的高危因素及预后。 方法 2011年1月至2014年3月诊治的200例下咽癌患者作为研究对象,回顾性分析患者的一般资料、肿瘤信息和随访情况。先对可能影响下咽癌共病同时性食管癌的危险因素进行单因素分析,组间比较采用卡方检验,进一步将有统计学差异的因素纳入Logistic回归分析。生存率的分析采用Kaplan-Meier法。 结果 单因素分析发现,年龄(<55岁)、男性、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的高危因素(P<0.05)。多因素分析结果显示,年龄(<55岁)、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的独立危险因素(P<0.05)。200例下咽癌患者中位生存时间仅为37.5个月,5年生存率仅为36.7%。56例下咽癌共病同时性食管癌患者中位生存时间为24.8个月,低于下咽癌不伴同时性食管癌患者(P<0.05)。早期食管癌(0+Ⅰ期)患者的中位生存时间为29.2个月,明显高于进展期食管癌(Ⅱ+Ⅲ期)的15.8个月,差异有统计学意义(P<0.05)。 结论 下咽癌共病同时性食管癌患者的生存时间较低。年龄(<55岁)、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的独立危险因素,临床上应该针对这些高危因素进行早期干预。     

Matched analysis of survival in patients with squamous cell carcinoma of the head and neck diagnosed before and after 40 years of age

OBJECTIVES: To compare the survival rates of patients 40 years or younger and diagnosed with squamous cell carcinoma of the head and neck (SCCHN) with those of patients older than 40 years who underwent the same treatment. In 2 previous matched-pair analyses, the patients had been matched for tumor stage, site, sex, and date of presentation but not type of treatment. METHODS: Between 1995 and 2001, 46 patients 40 years or younger participated in a prospective epidemiologic study that included more than 500 patients newly diagnosed with SCCHN. We matched each of these patients by sex, race, tumor site, overall stage, and treatment modality with 2 patients older than 40 years. Ultimately, 31 of the younger patients were matched with 62 of the older patients. Survival analysis was performed using Cox proportional hazard models and accounting for the matched trios. RESULTS: There was no difference in overall, disease-specific, or recurrence-free survival rates between the patients who were 40 years or younger and those older than 40 years. Furthermore, matched survival analysis did not demonstrate a difference in overall survival rate (risk ratio [RR], 0.71; 95% confidence interval [CI], 0.22-2.29; P =.56), disease-free survival rate (RR, 0.83; 95% CI, 0.20-3.33; P =.79), or time to recurrence (RR, 1.46; 95% CI, 0.50-4.23; P =.49), and was not affected by adjustment for medical comorbidities or the severity of cancer-associated symptoms. CONCLUSIONS: We found no evidence of a difference in the survival rates of patients with SCCHN who were 40 years or younger or older than 40 years and underwent similar treatment at our institution.     

Analysis of 2,500 squamous cell carcinoma of the head and neck

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages.     

Risk factors for distant metastases in head and neck squamous cell carcinoma

OBJECTIVES: To evaluate the frequency of distant metastases (DM) and to determine the ability of certain clinical and pathologic factors to predict the development of distant metastases. DESIGN: Retrospective analysis. SETTING: University hospital. PATIENTS: A total of 1972 patients with oral, oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinomas who were treated from 1981 to 1998 and who were not diagnosed as having DM at the time of initial treatment. MAIN OUTCOME MEASURES: We evaluated the frequency of DM and the influence of different variables in their appearance. RESULTS: A total of 181 patients (9.2%) (95% confidence interval, 7.9%-10.5%) developed DM. Younger age (<45 years), hypopharyngeal localization, an advanced T stage and/or N stage tumor according to the TNM staging system, high histologic grade, and locoregional control were found to be significantly associated with the risk of DM at both univariate and multivariate analyses. CONCLUSIONS: The incidence of DM in subjects with head and neck squamous cell carcinoma is relatively low. The risk of DM is influenced by age, site of primary cancer, local and/or regional extension, grading, and achievement of locoregional control.     

Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus neoadjuvant chemotherapy plus concurrent chemoradiotherapy for ascending or descending types of nasopharyngeal carcinoma: A retrospective study

PurposeThis study aimed to compare the efficacy between neoadjuvant chemotherapy (NACT) plus intensity-modulated radiotherapy (IMRT) and NACT plus concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC).Materials and methodsData from 603 patients with ascending (T4 and N0–1) or descending (T1–2&N3) NPC who were treated at Sun Yat-sen University Cancer Center between October 2009 and February 2012 were retrospectively analyzed. These patients were divided into two groups: NACT+IMRT (n = 302) and NACT+CCRT (n = 301). The primary endpoint was overall survival (OS), which was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards model, and landmark analysis.ResultsIn univariate analysis, there was no significant difference in 5-year OS between the NACT+IMRT and NACT+CCRT groups (hazard ration [HR]: 0.69; 95% confidence interval [CI]: 0.47–1.01; P = 0.057). However, after adjustment for age (<45 years, ≥45 years), gender, histological stage (I/II, III), T stage (1/2, 3, 4), and N stage (0/1, 2/3), NACT+IMRT was more effective in improving OS, with a 33% decrease in the risk of death than NACT+CCRT (HR: 0.67; 95%CI: 0.45–0.99). Furthermore, landmark analysis indicated that patients in the NACT+IMRT group had higher OS rates within 24 months (HR: 1.83; 95%CI: 1.00–3.34), whereas those treated with NACT+CCRT had higher OS rates after 24 months (HR, 0.47; 95% CI, 0.29–0.77). We also found significant survival benefits of NACT+IMRT regimen in patients younger than 45 years old (HR: 0.27; 95%CI: 0.14–0.49), and in those at stage T3 (HR: 0.50; 95%CI: 0.27–0.93) and stage N2/3 (HR: 0.52; 95%CI: 0.32–0.83).ConclusionPatients with ascending or descending NPC who are treated with NACT+IMRT may have better long-term survival outcomes than those treated with NACT+CCRT, especially the patients younger than 45 years old or in stage T3/N2/N3. Additionally, NACT+IMRT may be a better option than NACT+CCRT in patients within the first 24 months.     

Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study

PurposeTo characterize the significance of patient-level influences, including smoking history, on oncologic outcomes in human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC).Materials and methodsA bi-institutional retrospective cohort study of previously untreated, HPV+ OPC patients who underwent curative treatment from 1/1/2008 to 7/1/2018 was performed. The primary outcome was disease-free survival (DFS) and the primary exposure was ≤10 versus >10-pack-year (PY)-smoking history.ResultsAmong 953 OPC patients identified, 342 individuals with HPV+ OPC were included. The median patient age was 62 years, 33.0% had a > 10-PY-smoking history, 60.2% had AJCC8 stage I disease, and 35.0% underwent primary surgery. The median follow-up was 49 months (interquartile range [IQR] 32–75 months). Four-year DFS-estimates were similar among patients with ≤10-PY-smoking history (78.0%, 95% CI:71.7%–83.1%) compared to >10-PYs (74.8%; 95% CI:65.2%–82.0%; log-rank:p = 0.53). On univariate analysis, >10-PY-smoking history did not correlate with DFS (hazard ratio[HR]:1.15;95% CI:0.74–1.79) and remained nonsignificant when forced into the multivariable model. On adjusted analyses, stage, treatment paradigm, and age predicted DFS. Neither >10-PYs, nor any other definition of tobacco use (e.g., current smoker or > 20-PYs) was predictive of DFS, overall survival, or disease-specific survival. Conversely, age nonsignificantly and significantly predicted adjusted DFS (adjusted HR[aHR]:1.02,95% CI:0.997–1.05, p = 0.08), overall survival (aHR 1.05; 95% CI: 1.02–1.08; p = 0.002) and disease-specific survival (aHR 1.04;95% CI: 0.99–1.09;p = 0.09).ConclusionOther than age, patient-level influences may not be primary drivers of HPV+ OPC outcomes. Although limited by its modest sample size, our study suggests the significance of smoking has been overstated in this disease. These findings and the emerging literature collectively do not support risk-stratification employing the >10-PY threshold.Level of evidenceLevel 4