Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach

Sadeghi, N.; Li, Ning-Wei; Taheri, M. Reza; Easley, Samantha; Siegel, Robert S.

doi:10.1002/hed.24526

Cited by 24 publications

(31 citation statements)

References 38 publications

(77 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Most trials have defined de-escalation following surgery as either reducing the dose of adjuvant radiation therapy or entirely omitting chemotherapy from adjuvant or definitive treatment. 9 Computed tomography (CT) and/or magnetic resonance imaging (MRI) of the neck was used prior to induction chemotherapy and postchemotherapy prior to surgical resection. 8 Distant-only metastatic recurrence accounts for almost 50% of all failures and remains a challenge that is not addressed with the current standard of treatment or other de-escalation trials.…”

Section: Introductionmentioning

confidence: 99%

“…The feasibility of the approach is previously reported. 9 Computed tomography (CT) and/or magnetic resonance imaging (MRI) of the neck was used prior to induction chemotherapy and postchemotherapy prior to surgical resection. Previous studies have shown that, although there is a risk of false-positive results, FDGpositron emission tomography (PET) can potentially be similar in effectiveness in predicting tumor volume reduction when compared to endoscopic examination under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pathologic response to neoadjuvant chemotherapy in HPV‐associated oropharynx cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: A paradigm shift has led to de-escalation trials for the treatment of HPV-positive oropharynx cancer (OPC). The objective of this study was to assess the ability of tumor volume reduction on imaging to predict pathological response to neoadjuvant chemotherapy in patients with HPV-positive OPC.Methods: A prospective observational study of 54 patients with HPV-positive OPC enrolled in a clinical trial of neoadjuvant chemotherapy followed by surgery was performed. Patients underwent three cycles of induction chemotherapy (cisplatin/docetaxel); prechemotherapy and postchemotherapy imaging were obtained. Receiver operating characteristic curves and logistic regression analyses were used. Results: The complete pathologic response (pCR) rate at primary and nodal sites were 72% and 57%, respectively. Tumor volume reduction of ≥90% following induction chemotherapy predicted pCR of the primary tumor. Conclusions: Neoadjuvant chemotherapy followed by definitive transoral surgery is a new paradigm worthy of further investigation and MRI is a reliable modality to assess preoperative response.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathologic response to neoadjuvant chemotherapy in HPV‐associated oropharynx cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…The value contributed by the addition of 5‐FU into an induction chemotherapy regimen is controversial. Although most induction trials have used TPF triple therapy, a small set of articles have been published using TP‐based induction chemotherapy . These articles show similar efficacy and substantially lower toxicity profiles, therefore improving the viability and adherence to induction protocols.…”

Section: Discussionmentioning

confidence: 99%

Presurgical induction chemotherapy for squamous cell carcinoma of the tonsil

et al. 2019

View full text Add to dashboard Cite

Objectives/Hypothesis: The indications for and efficacy of induction chemotherapy in the management of squamous cell carcinoma of the head and neck is controversial. With the advent of human papillomavirus (HPV)-related cancers, survival has improved significantly. Here we present a group of patients with tonsil cancer treated with induction chemotherapy followed by surgery.Study Design: Retrospective cohort study. Methods: Thirty-eight patients with tonsil cancer were treated with induction chemotherapy, consisting of cisplatin and docetaxel, followed by neck dissection and radical tonsillectomy. Twenty-six patients were HPV+, 28 were nonsmokers or long-term former smokers, and 28 were T1/T2. Fourteen patients required postoperative chemoradiotherapy (CRT). Median follow-up time was 4.1 years.Results: A complete response to induction chemotherapy was achieved in 45% (17) of patients. In total, 76% (29/38) of patients were successfully treated: 53% (20/38) with chemotherapy and surgery alone, and 24% (9/38) required postoperative CRT. Almost 90% (23/26) of HPV+ and half (6/12) of HPV− patients are no evidence of disease (NED). HPV status is a significant prognostic factor (P = .02). Only 38% (5/13) of current smokers were NED compared to 96% (24/25) of nonsmokers (P = .0002). All HPV+ nonsmokers (20/20) were NED at last follow-up.Conclusions: In this study, the primary driver of prognosis was smoking status. HPV status and T stage were also important. The prognosis for HPV+ nonsmokers is extremely good; most likely regardless of treatment. Treatment failures have a poor chance of salvage, irrespective of treatment type. With the major exception of HPV− smokers, induction chemotherapy followed by surgery with selective CRT is a viable treatment option for tonsil cancer.

show abstract

“…The results of this trial and other de-escalation trials will determine if treatment reduction is appropriate in patients with HPV-positive oropharyngeal cancers. Sadeghi et al (43) reported use of TORS after induction chemotherapy without any RT in 17 patients; this treatment failed in only one patient.…”

Section: Surgerymentioning

confidence: 99%

Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art

2019

View full text Add to dashboard Cite

During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human papillomavirus (HPV). HPVdriven p16-positive OPSCC and tobacco-related OPSCC differ in their underlying molecular and genetic profiles, socioeconomic demographics, and response to treatment. HPV-related OPSCC tends to occur in younger patients and has a significantly better response to treatment and excellent prognosis. The stark contrast in prognosis-with around 90% overall 5-year survival for HPV-related p16-positive OPSCC and 40% for non-HPV-related p16-negative OPSCC-has prompted major changes in the eighth edition of the staging manual of the AJCC (American Joint Committee on Cancer). The past 10-15 years have also witnessed major advances in surgery, radiation therapy (RT), and systemic therapy. Minimally invasive surgery has come of age, with transoral robotic procedures and laser microsurgery. Intensity-modulated RT (IMRT) and more recently proton-beam RT have markedly improved the conformity of RT, with an ability to precisely target the cancer and cancer-bearing regions while sparing normal structures and significantly reducing long-term treatment-related morbidity. Progress in systemic therapy has come in the form of immunotherapy and targeted agents such as cetuximab. Owing to the better prognosis of HPV-driven OPSCC as well as the morbidity associated with treatment, de-escalation of therapy via multiple strategies is being explored. The article reviews the advances in diagnosis and multidisciplinary management of OPSCC in the HPV era. ©

show abstract

Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach

Cited by 24 publications

References 38 publications

Pathologic response to neoadjuvant chemotherapy in HPV‐associated oropharynx cancer

Pathologic response to neoadjuvant chemotherapy in HPV‐associated oropharynx cancer

Presurgical induction chemotherapy for squamous cell carcinoma of the tonsil

Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art

Contact Info

Product

Resources

About