Cancer Research and Treatment

Original Articles

Head and Neck cancer

Outcomes of Salvage Therapy for Oropharyngeal Cancer Recurrence Following Upfront Radiation Therapy and Prognostic Factors: Nayeon Choi, Hack Jung Kim, Heejun Yi, Heejung Kim, Tae Hwan Kim, Han-Sin Jeong, Young-Ik Son, Chung-Hwan Baek, Dongryul Oh, Yong Chan Ahn, Man Ki Chung; Cancer Res Treat. 2023;55(4):1123-1133. Published online May 8, 2023; DOI: https://doi.org/10.4143/crt.2022.1046

Purpose
This study aimed to investigate the oncologic outcomes and prognostic factors of salvage treatments in patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after radiotherapy (RT)-based treatment.
Materials and Methods
A cancer registry was used to retrieve the records of 337 patients treated with definitive RT or concurrent chemoradiotherapy (CRT) from 2008 to 2018 at a single institution. The poor-responder group (PRG) was defined as patients with residual or recurrent disease after primary treatment, and the oncologic outcomes for each salvage treatment method were analyzed. In addition, prognostic indicators of recurrence-free survival (RFS) and overall survival (OS) were identified in patients who underwent salvage treatment.
Results
After initial (C)RT, the PRG comprised 71 of the 337 patients (21.1%): 18 patients had residual disease, and 53 had recurrence after primary treatment (mean time to recurrence 19.5 months). Of these, 63 patients received salvage treatment (surgery 57.2%, re-(C)RT 23.8%, and chemotherapy 19.0%), and the salvage success rate was 47.6% at the last follow-up. The overall 2-year OS for salvage treatments was 56.4% (60.8% for the salvage surgery group and 46.2% for the salvage re-(C)RT). Salvage surgery patients with negative resection margins had better oncologic outcomes than those with close/positive resection margins. Using multivariate analyses, locoregional recurrence and residual disease after primary surgery were associated with poor outcome after salvage treatment. In Kaplan-Meier analyses, p16 status was significantly associated with OS in the initial treatment setting but not in the salvage setting.
Conclusion
In recurrent OPSCC after RT-based treatment, successful salvage was achieved in 56.4% patients who had undergone salvage surgery and radiation treatment. Salvage treatment methods should be selected carefully, given recurrence site as a prognostic factor for RFS.

Citations

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Impact of Prior Neck Treatment Status on Salvage Treatment Outcomes in Isolated Regional Recurrence of Head and Neck Squamous Cell Carcinoma
Younghac Kim, Heechun Cho, Nayeon Choi, Man Ki Chung, Han‐Sin Jeong, Young‐Ik Son
Head & Neck.2025;[Epub] CrossRef
Toxicities and prognostic factors in elderly HPV‐associated oropharyngeal cancer patients treated with radiotherapy or chemoradiotherapy
Erkan Topkan, Efsun Somay, Ugur Selek
Journal of Medical Virology.2024;[Epub] CrossRef

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Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer: Dong-Yun Kim, Hong-Gyun Wu, Jin Ho Kim, Joo Ho Lee, Soon-Hyun Ahn, Eun-Jae Chung, Keun-Yong Eom, Young Ho Jung, Woo-Jin Jeong, Tack-Kyun Kwon, Suzy Kim, Chan Woo Wee; Cancer Res Treat. 2022;54(2):406-416. Published online June 23, 2021; DOI: https://doi.org/10.4143/crt.2021.441

Abstract PDF Supplementary Material PubReader ePub

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.

Citations

Citations to this article as recorded by

Definitive radio(chemo)therapy versus upfront surgery in the treatment of HPV-related localized or locally advanced oropharyngeal squamous cell carcinoma
Jérémy Baude, Caroline Guigou, David Thibouw, Noémie Vulquin, Mireille Folia, Guillaume Constantin, Jihane Boustani, Christian Duvillard, Sylvain Ladoire, Gilles Truc, Aurélie Bertaut, Cédric Chevalier, Scott M. Langevin
PLOS ONE.2024; 19(7): e0307658. CrossRef
INFLUENCE OF CONFORMAL RADIOTHERAPY IN COMBINATION WITH RADIOMODIFIERS ON THE CONTENT OF VEGF, COX-2, AND PGE-2 IN BLOOD SERUM OF PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA
N. MITRYAYEVA, L. GREBINYK, S. ARTIUKH, N. BILOZOR, V. STARENKIY
Experimental Oncology.2024; 46(3): 253. CrossRef
Assessment of Radiologic Extranodal Extension Using Combinatorial Analysis of Nodal Margin Breakdown and Metastatic Burden in Oropharyngeal Cancer
Sungryeal Kim, Hannah Park, Se Hyun Yeou, Jin Roh, Yoo Seob Shin, Chul-Ho Kim, Eun Ju Ha, Jeon Yeob Jang
Cancers.2023; 15(13): 3276. CrossRef
Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review)
Chun Wei, Xiaojun Lan, Maona Qiu, Ran Cui, Qiuxia Fu, Shafiu Umar Shinge, Tobias Muluh, Ou Jiang
Oncology Letters.2023;[Epub] CrossRef

8,419 View
234 Download
3 Web of Science
4 Crossref

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