It is not just IMRT: Human papillomavirus related oropharynx squamous cell carcinoma is associated with better swallowing outcomes after definitive chemoradiotherapy

Naik, Mihir; Ward, Matthew C.; Bledsoe, Turner; Kumar, Aryavarta M. S.; Rybicki, Lisa; Saxton, Jerrold P.; Burkey, Brian B.; Greskovich, J.F.; Adelstein, David J.; Koyfman, Shlomo A.

doi:10.1016/j.oraloncology.2015.04.008

Cited by 23 publications

(34 citation statements)

References 29 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Combined analysis of prior RTOG studies (RTOG 91‐11, 97‐03, and 99‐14) found severe late toxicity of 35% in all patients with OPSCC . This was before knowledge of HPV status and also did not account for smoking, both of which have been reported to independently predict for late toxicity risk in patients with OPSCC . Severe late toxicity in HPV + patients in the DAHANCA 6/7 and RTOG 0129 trials ranged from 20% to 26%, which is still considerably higher than the rate of late toxicity reported in the current study cohort (9%).…”

Section: Discussioncontrasting

confidence: 59%

Determining optimal follow‐up in the management of human papillomavirus‐positive oropharyngeal cancer

Frakes

Naghavi

Demetriou

et al. 2015

Cancer

View full text Add to dashboard Cite

BACKGROUND Determining the optimal follow‐up for patients can help maximize the use of health care resources. This is particularly true in a growing epidemic such as human papillomavirus‐positive oropharyngeal squamous cell carcinoma (HPV+OPSCC). The objective of the current study was to evaluate time to disease recurrence or late toxicity in this cohort of patients to optimize patient management. METHODS An institutional database identified 232 patients with biopsy‐proven, nonmetastatic HPV+OPSCC who were treated with radiotherapy. A retrospective review was conducted in patients who were followed every 3 months for the first year, every 4 months in year 2, and every 6 months in years 3 to 5. Late toxicity (grade ≥ 3; toxicity was scored based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4]), locoregional control, distant control, and overall survival were assessed. RESULTS The median follow‐up was 33 months. Based on Radiation Therapy Oncology Group (RTOG) 0129 study risk groupings, patients were either considered to be at low (162 patients; 70%) or intermediate (70 patients; 30%) risk. Concurrent systemic therapy was used in 85% of patients (196 patients). The 3‐year locoregional control, distant control, and overall survival rates were 94%, 91%, and 91%, respectively. Late toxicity occurred in 9% of patients (21 patients). Overall, 64% of toxicity and failure events occurred within the first 6 months of follow‐up, with a < 2% event incidence noted at each subsequent follow‐up. Only 4 patients experienced their first event after 2 years. CONCLUSIONS HPV+OPSCC has a low risk of disease recurrence and late toxicity after treatment; approximately two‐thirds of events occur within the first 6 months of follow‐up. These data suggest that it may be reasonable to reduce follow‐up in patients with HPV+OPSCC to every 3 months for the first 6 months, every 6 months for the first 2 years, and annually thereafter. Cancer 2016;122:634–641. © 2015 American Cancer Society.

show abstract

Section: Discussioncontrasting

confidence: 59%

Determining optimal follow‐up in the management of human papillomavirus‐positive oropharyngeal cancer

Frakes

Naghavi

Demetriou

et al. 2015

Cancer

View full text Add to dashboard Cite

show abstract

“…In addition, studies 19,20 suggest that patients with non–HPV-associated head and neck cancer may experience worse symptoms compared with patients with HPV-associated tumors. It is unclear what effect tumor HPV status may have on agreement between patient- and practitioner-reported toxic effects.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Patient- and Practitioner-Reported Toxic Effects Associated With Chemoradiotherapy for Head and Neck Cancer

Falchook

Green

Knowles

et al. 2016

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Agreement between patient- and practitioner-reported toxic effects during chemoradiotherapy for head and neck cancer is unknown. OBJECTIVE To compare patient-reported symptom severity and practitioner-reported toxic effects among patients receiving chemoradiotherapy for head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS Forty-four patients participating in a phase 2 trial of deintensified chemoradiotherapy for oropharyngeal carcinoma were included in the present study (conducted from February 8, 2012, to March 2, 2015). Most treatment (radiotherapy, 60 Gy, with concurrent weekly administration of cisplatin, 30mg/m2) was administered at academic medical centers. Included patients had no prior head and neck cancers, were 18 years or older, and had a smoking history of 10 pack-years or less or more than 10 pack-years but 30 pack-years or less and abstinent for the past 5 years. Cancer status was untreated human papillomavirus or p16-positive squamous cell carcinoma of the oropharynx or unknown head and neck primary site; and cancer staging was category T0 to T3, category N0 to N2c, M0, and Eastern Cooperative Oncology Group performance status 0 to 1. Baseline, weekly, and posttreatment toxic effects were assessed by physicians or nurse practitioners using National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Patient-reported symptom severity was measured using the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE). Descriptive statistics were used to characterize raw agreement between CTCAE grades and PRO-CTCAE severity ratings. INTERVENTIONS Baseline, weekly, and posttreatment toxic effects assessed using CTCAE, version 4.0, and PRO-CTCAE. MAIN OUTCOMES AND MEASURES Raw agreement indices between patient-reported toxic effects, including symptom frequency, severity, and interference with daily activities (score range, 0 [none] to 4 [very severe]), and practitioner-measured toxic effects, including swallowing, oral pain, and hoarseness (score range, 1 [mild] to 5 [death]). RESULTS Of the 44 patients included in the analysis (39 men, 5 women; mean [SD] age, 61 [8.4] years), there were 327 analyzable pairs of CTCAE and PRO-CTCAE symptom surveys and no treatment delays due to toxic effects. Patient-reported and practitioner-reported symptom severity agreement was high at baseline when most symptoms were absent but declined throughout treatment as toxic effects increased. Most disagreement was due to lower severity of toxic effects reported by practitioners (eg, from 45% agreement at baseline to 27% at the final week of treatment for pain). This was particularly noted for domains that are not easily evaluated by physical examination, such as anxiety and fatigue (eg, severity of fatigue decreased from 43% at baseline to 12% in the final week of treatment). CONCLUSIONS AND RELEVANCE Practitioner-reported toxic effects are lower than patient self-reports during head and neck chemoradiotherapy. The inclusion of patient-reported symptomatic toxic...

show abstract

“…Of the 128 patients (43.1%) who did not receive a prophylactic feeding tube, 11.7% required a reactive feeding tube for a median duration of 3.3 months (100.4 days). Naik and colleagues reviewed 147 patients with oropharynx cancer (130 HPV‐positive) to understand the impact of HPV itself on swallowing outcomes . Those authors noted that patients who had HPV‐positive cancers had a statistically significant decrease in feeding tube dependence (4% vs 18%; P = .02).…”

Section: Discussionmentioning

confidence: 99%

Reduced feeding tube duration with intensity‐modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results‐Medicare Analysis

Beadle

Liao

Giordano

et al. 2016

Cancer

View full text Add to dashboard Cite

Background Intensity-modulated radiation therapy (IMRT) is a technologically advanced and resource-intensive method of delivering radiation therapy (RT) used to minimize toxicity for patients with head and neck cancers (HNC). Dependence on feeding tubes is a significant marker of toxicity of RT. The goal of this analysis was to compare the placement and duration of feeding tube use for patients with HNC from 1999-2011. Methods The cohort, demographics, and cancer-related variables were determined using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database and analyzed regarding treatment details using claims data. Results A total of 2993 patients were identified. With a median follow-up of 47 months, 54.4% of patients had a feeding tube placed. The median duration from feeding tube placement to removal was 277 days. On zero-inflated negative binomial regression, patients treated with IMRT and 3DRT (non-IMRT) had similar rates of feeding tube placement (odds ratio (OR) 1.10; p=.35); however, patients treated with 3DRT had the feeding tube in place 1.18 times longer than those treated with IMRT (p=.03). The difference was only seen amongst patients treated with definitive radiation; patients treated with surgery and adjuvant radiation had no statistically significant difference in placement or duration. Conclusions Patients with HNC treated with definitive IMRT had significantly shorter duration of feeding tubes in place than those treated with 3DRT. These data suggest that there may be significant quality of life benefits to IMRT with respect to long-term swallowing function for patients.

show abstract

It is not just IMRT: Human papillomavirus related oropharynx squamous cell carcinoma is associated with better swallowing outcomes after definitive chemoradiotherapy

Cited by 23 publications

References 29 publications

Determining optimal follow‐up in the management of human papillomavirus‐positive oropharyngeal cancer

Determining optimal follow‐up in the management of human papillomavirus‐positive oropharyngeal cancer

Comparison of Patient- and Practitioner-Reported Toxic Effects Associated With Chemoradiotherapy for Head and Neck Cancer

Reduced feeding tube duration with intensity‐modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results‐Medicare Analysis

Contact Info

Product

Resources

About