Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s):To assess patterns of care and outcomes with the use of neoadjuvant chemotherapy followed by definitive radiation in human papillomavirus (HPV)-positive locally advanced oropharyngeal carcinoma (OPC).
Materials/Methods:We queried the National Cancer Database for patients with locally advanced HPV-positive OPC, defined as stages cT3-4cN2 or cT1-4cN3 who received concurrent chemoradiotherapy or neoadjuvant chemotherapy followed by radiotherapy. Neoadjuvant chemotherapy was defined as patients who received chemotherapy ≥21 days before starting radiation therapy. Multiple logistic regression was performed to identify variables significantly associated with the receipt of neoadjuvant chemotherapy. Overall survival (OS) was analyzed using the Kaplan-Meier method, propensity-score matching, and a Cox proportional hazards model adjusting for demographic and disease specific prognostic factors.
Results:From 2010-2014, a total of 990 patients were identified, including 246 who received neoadjuvant chemotherapy followed by radiotherapy and 744 who received concurrent chemoradiotherapy. In those who received neoadjuvant chemotherapy, the median number of days from starting chemotherapy to starting radiation therapy was 72 days (IQR 56-85 days). Neoadjuvant chemotherapy was significantly associated in patients with stage cT4 (adjusted Odds Ratio (aOR) 2.08, 95% CI 1.06-4.10, p = 0.034) and stage cN3 disease (aOR 2.29, 95% CI 1.38-3.76, p = 0.001). With a median follow-up of 30.1 months, the neoadjuvant group had a 2-year OS of 79% compared with 84% in those who received concurrent chemoradiotherapy (log-rank p = 0.24). Results were consistent in subgroup analysis of patients with age <70 and Charlson/Deyo score of 0. On multivariate adjusted Cox regression, the neoadjuvant group did not show a significant difference in mortality risk (adjusted hazard ratio; 1.10, 95% CI 0.83-1.47, p = 0.51). In a propensity-score matched population of 492 patients (246 with neoadjuvant chemotherapy and 246 with concurrent chemoradiotherapy), there was no significant survival difference associated with neoadjuvant chemotherapy (hazard ratio 1.15, 95% CI 0.81-1.64, p = 0.44).
Conclusion:In this large hospital-based analysis, neoadjuvant chemotherapy was used in 25% of patients with locally advanced HPV-positive OPC but was not significantly associated with a survival benefit.
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