Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
MO_25_2582 - Human papillomavirus-associated squamous cell carcinoma of the larynx: a retrospective analysis of incidence and clinical outcomes
Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3
Ryan Hughes, MD
Wake Forest Baptist Medical Center
Wake Forest Baptist Medical Center: Resident physician: Employee
Human papillomavirus-associated squamous cell carcinoma of the larynx: a retrospective analysis of incidence and clinical outcomes
R. T. Hughes1, A. H. Masters1, C. A. Helis1, M. Porosnicu2, J. D. Waltonen3, B. A. Frizzell1, S. S. O'Neill4, and K. M. Greven1; 1Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC, 2Department of Hematology & Oncology, Wake Forest School of Medicine, Winston Salem, NC, 3Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC, 4Department of Pathology, Wake Forest School of Medicine, Winston Salem, NC
Purpose/Objective(s): The role of human papillomavirus (HPV) infection in the development of squamous cell carcinoma (SCC) of the oropharynx is well-established. Additionally, patients treated with radiotherapy for HPV-associated oropharyngeal SCC exhibit improved clinical outcomes compared to their HPV-negative counterparts. The reported incidence of HPV detection in laryngeal SCC may be estimated at approximately 20-30%. The clinical impact of HPV infection in these patients is as of yet unclear.
Materials/Methods: In this IRB-approved study, 500 patients with laryngeal cancer treated at our institution between 2012-2017 were identified. Patients with primary, non-metastatic SCC of the larynx who received radiotherapy as part of their multidisciplinary management were included. HPV status was obtained from the medical record in available patients. Clinicopathologic features were recorded and analyzed for association with HPV positivity. Overall survival (OS), locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and compared between HPV status groups using the log-rank test.
Results: Of 109 patients eligible for inclusion, 33 (30%) underwent upfront surgical resection, all received radiotherapy (definitive in 71%, postoperative in 29%), and 61 (56%) received concurrent chemotherapy with radiotherapy. Median clinical follow-up was 22 months (range, 1.6-69.4) and radiographic follow-up was 14.8 months (range, 3.9-58.7). HPV testing was performed in 23 patients: p16 immunohistochemistry (p16) alone in 2, HPV DNA PCR in 16, and both p16 and PCR in 5 patients. HPV was detected in 8 (35%) patients and not detected in 15 (65%). Baseline patient and treatment characteristics including age, gender, race, ECOG, smoking status, tumor subsite and clinical stage did not differ between groups. All HPV-positive patients were treated with definitive radiotherapy with or without concurrent chemotherapy. Fewer pack-years of smoking was associated with HPV detection (median 10 v. 34 pack-years, p<0.01). Of 4 p16-positive patients, HPV was confirmed by PCR in 3 patients (75%). One p16-negative patient was confirmed negative by PCR. In patients with HPV-positive compared to HPV-negative tumors, 3-year OS was 80% v. 58% (p=0.67), 3-year LRFFS was 64% v. 55% (p=0.74), and 3-year DFS was 64% v. 58% (p=0.72).
Conclusion: In this single-institution experience, HPV was detected in 35% of laryngeal SCC patients. Locoregional control, disease-free survival and overall survival were similar for patients with HPV-negative and HPV-positive tumors. Incomplete information regarding HPV status within this cohort limits the power of these analyses. Further evaluation of the incidence of HPV-associated SCC of the larynx and its impact on clinical outcomes and response to therapy is warranted.
Author Disclosure: R.T. Hughes: None. A.H. Masters: None. C.A. Helis: None. J.D. Waltonen: None.