Outcomes and Prognostic Grouping of Human Papillomavirus–Positive Oropharyngeal Squamous Cell Carcinoma Undergoing TORS/TLM and Adjuvant Radiation Therapy

Abstract

To study the impact of tumor doubling time and primary tumor specific growth rate (SGR) for non-oropharyngeal head and neck cancers (Non-OPC) on treatment outcomes after definitive radiation therapy (RT). Materials/Methods: A total of 39 non-OPC patients managed with radiation (RT) or chemoradiation (CRT) with measurable primary tumor on a diagnostic scan prior to CT simulation and with no interval treatment were analyzed. Diagnostic CT scan images of all patients were imported into a commercially available contouring system and fused with the radiation treatment planning scan using deformable registration. The diagnostic tumor and nodal volumes were contoured and compared to the planning scan volumes. A tumor doubling time was calculated from these two volumes. We included 30 patients in final analysis who had a quantifiable SGR, rest of them had an SGR of 0. Overall survival (OS), progression free survival (PFS), and local recurrence (LR) were evaluated according to the Kaplan Meier method and hazard ratios were estimated using Cox Regression. We stratified patients into low versus high tumor specific growth rate according to the median tumor SGR of 1.388 per day. Results: Of 39 patients, 36 patients had laryngeal and 3 had hypopharyngeal cancers. 24 were Stage III or IV (62%). Eleven patients got RT alone and 28 (72%) were treated with CRT. Median RT dose was 70Gy (range 60-79.2). The median time between acquisition of diagnostic and simulation CT scans was 22 days (range 7-170 days). Median SGR was 0.92%/day (range 0.04-7.3). Seven patients got recurrent disease locally (18%). The average doubling time for recurrent tumors was 2.1% per day (range 0-7.3). The median follow up was 2.4 years with a median overall survival of 3.8 years. OS at median follow up was 87% for the low tumor SGR versus 64% for the high tumor SGR group (P Z 0.053). There was a trend towards increased overall mortality among patients with high tumor SGR values (HR [95% CI] Z 3.40 [0.91-12.64], P Z 0.068). Similarly, PFS at median follow up was 87% for the low tumor SGR group versus 67% for the high tumor SGR group (P Z 0.053). There was a trend towards worse PFS among patients with high tumor SGR values (HR [95% CI] Z 2.63 [0.81-8.62], P Z 0.109). However, we noted no statistically significant difference in LR rates according to tumor SGR with 7% of low tumor SGR versus 23% of high tumor SGR patients experiencing LR at the median follow up (P Z 0.441) (HR [95% CI] Z 1.99 [0.33-11.95]), P Z 0.450). Conclusion: Tumor doubling time of more than 1.388% per day correlates to significant detrimental effect on tumor control in non-OPC cancers. Although limited in power by small sample size, our analysis supports a trend towards increased overall mortality and local recurrence risk among patients with high tumor specific growth rate. Means to reduce it include shortening of time interval between diagnostic and simulation scans.

Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis

“…Figure displays the results of the review process in a PRISMA flowchart. On detailed review of full text articles, many records were ineligible as they were review articles, did not report any TORS salvage cases, the salvage cases were indistinguishable from the primary cases/combined cohort, there were insufficient survival data, reports were only conference abstracts, related to nasopharyngeal carcinoma only, or the reports were superseded by more contemporary publications from the relevant institutions . A total of eight studies met the eligibility criteria and have been presented in the results …”