Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_31_2733 - Practice Patterns in Human Papilloma Virus-Associated Oropharyngeal Cancer and Strategies for Deintensification of Therapy: A Nationwide Survey of Radiation Oncologists

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

Practice Patterns in Human Papilloma Virus-Associated Oropharyngeal Cancer and Strategies for Deintensification of Therapy: A Nationwide Survey of Radiation Oncologists
J. W. Snider III1, J. K. Molitoris2, A. M. Chhabra3, C. DeCesaris4, N. Onyeuku1, S. R. Rice3, M. A. L. Vyfhuis5, K. Hatten6, and S. J. Feigenberg4; 1University of Maryland School of Medicine, Baltimore, MD, 2Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, 3Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, 4Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 5Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 6University of Maryland School of Medicine, Annapolis, MD

Purpose/Objective(s): In the absence of large clinical trial results, practice patterns have varied as to utilization of deintensification strategies in human papilloma virus-associated oropharyngeal cancer (HPV-OPC) and as to up-front management of these malignancies. We hypothesized that there is substantial heterogeneity amongst radiation oncologists as to treatment recommendations for HPV-OPC.

Materials/Methods: An IRB-approved survey was developed and distributed electronically through a third-party website. Survey questions focused on demographics of respondents, setting of clinical practice, region of practice, preferred deintensification strategies, recommendations based on extent of extracapsular extension (ECE) in resected HPV+ nodes, institutional use of transoral robotic surgery (TORS), and 2 clinical vignettes highlighting controversial cases. A Pearson’s correlation test was utilized for statistical analysis.

Results: A total of 111 radiation oncologists (105 attendings/practicing physicians, 6 residents) responded (100 complete, 11 partial) to the survey. Respondents identified their current positions as at major academic hospitals (40.5%), non-academic hospitals (27.9%), satellite/community sites of major academic facilities (17.1%), and private practices (14.4%). Respondents were divided as to the “ideal” form of deintensification in HPV-OPC. While 40.6% felt that chemoradiation (ChemoRT) with reduced RT dose to 60 Gy best served patients, 35.9% preferred TORS followed by adjuvant therapy as indicated. The remaining practitioners selected altered fractionation RT (AFX-RT) (60 Gy/5 weeks, 10.4%), induction chemotherapy followed by ChemoRT (4.7%), or other (8.5%). Respondents were more likely to recommend TORS with neck dissection in HPV-OPC than in HPV-negative disease regardless of radiographic lymph node size (47.5% vs 40.6%) or with nodes <6 cm (21.8% vs 16.8%); nodes <3cm (25.7% vs 38.6%). There was also significant consideration of omission of chemotherapy in postoperative patients with HPV-OPC and minimal ECE (<2mm) (31.7%), while 64.4% still regularly prescribe ChemoRT. Others (3.8%) consider RT alone regardless of ECE extent. In a patient with cT2N2aM0 HPV-OPC of the base of tongue, preferred respondent up-front approaches were ChemoRT (55%), TORS with adjuvant therapy as indicated (37%), AFX-RT (6%), and other (2%). In a patient with pT1N1MX HPV-OPC of the tonsil after TORS (3mm margin, no ECE/LVSI/PNI), practitioners were evenly split as to whether to offer adjuvant RT: observation 51%, RT 47%, other 2%.

Conclusion: Optimal management and therapy deintensification strategies for patients with HPV-OPC remain controversial. Forthcoming clinical trial data should substantially inform therapeutic recommendations and practice guidelines.

Author Disclosure: J.W. Snider: None. J.K. Molitoris: None. A.M. Chhabra: None. N. Onyeuku: None. S.R. Rice: None. S.J. Feigenberg: None.

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