Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_31_2476 - The Impact of Extra-Nodal Extension on Survival in Patients with HPV+ Oropharyngeal Squamous Cell Carcinoma Treated with Adjuvant Radiation Therapy

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

The Impact of Extra-Nodal Extension on Survival in Patients with HPV+ Oropharyngeal Squamous Cell Carcinoma Treated with Adjuvant Radiation Therapy
S. Baliga1, R. Kabarriti2, C. Guha3, S. Kalnicki2, and M. K. Garg2; 1Montefiore Medical Center, Bronx, NY, 2Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 3Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Purpose/Objective(s): To compare survival outcomes for patients with either HPV negative or positive Oropharyngeal Squamous Cell Carcinoma (OPSCC) undergoing Trans-Oral Robotic Surgery (TORS) and who were treated without adjuvant chemotherapy with positive extra-nodal extension (ENE).

Materials/Methods: We identified all non-metastatic OPSCC patients who received TORS for the upfront management of OPSCC from the National Cancer Database registry between 2010-2014. Patients were selected who had either HPV- or HPV+ disease with ENE and who were treated with adjuvant radiotherapy (RT) alone. Overall Survival (OS) was measured from time of diagnosis until death or last follow up and the Kaplan-Meier method was used to estimate OS.

Results: A total of 402 patients were identified who were treated with TORS between 2010-2014 and who had ENE. Of these patients, 62 (15.4%) were HPV positive with ENE and were treated with adjuvant RT alone (median dose of 60 Gy). 58 (93.5%) of patients presented with a tonsil primary and only 4 patients (6.5%) presented with a base of tongue primary. Approximately 72.5% of patients had ≤3 lymph nodes positive. Of the 62 patients, 24 (53.3%) had microscopic ENE only, 6 (9.6%) had macroscopic ENE, and in 32 patients the extent of ENE was unknown. Median follow up was 29.5 months. 5-year actuarial OS was 100% in this cohort. In comparison, only 13 patients (14.9%) were identified with HPV negative disease with ENE and treated with adjuvant RT alone (median dose of 60 Gy). Median follow up of this cohort was 26.7 months. The 2-year actuarial OS in this cohort was 66.6%.

Conclusion: For selected patients with HPV positive OPSCC with pathologic finding of ENE, especially those with only microscopic ENE, adjuvant RT in the absence of chemotherapy may be a feasible option with no impact on OS.

Author Disclosure: S. Baliga: None. R. Kabarriti: None. C. Guha: Translational Research Program, Gastrointestinal O; RTOG. S. Kalnicki: Travel Expenses; Varian Oncology Systems. Committee Member; American College of Radiology. M.K. Garg: Speaker's Bureau; Varian, Covidien.

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