Head and Neck Cancer

SS 31 - H&N 3 - Strategies to Improve Outcomes and Minimize Toxicity in Oropharyngeal Cancer

230 - Long Term Outcomes in Patients With Recurrent HPV-Related Oropharyngeal Cancer

Tuesday, October 23
5:55 PM - 6:05 PM
Location: Room 214 A/B

Long Term Outcomes in Patients With Recurrent HPV-Related Oropharyngeal Cancer
W. Su1, B. Barber1, B. Miles1, K. Misiukiewicz1, V. Gupta1, and R. L. Bakst2; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Icahn School of Medicine at Mount Sinai Department of Radiation Oncology, New York, NY

Purpose/Objective(s): HPV derived oropharyngeal cancers (OPC) are known to have favorable clinical outcomes. However, the clinical course following failure is poorly described. This study aims to characterize disease course and identify prognostic factors following failure for patients with HPV driven OPC.

Materials/Methods: After IRB approval, we identified all patients with HPV derived OPC treated at our institution from 2007 to 2017. Patient HPV status was confirmed with immunohistochemistry staining or HPV DNA PCR. All patients included had no evidence of disease after initial treatment and subsequently a biopsy proven recurrence. Locoregional failure was defined as patients who failed in the primary tumor site, or neck. Patient characteristics, treatment modalities and post-recurrence outcomes were analyzed.

Results: 354 HPV derived OPC patients were treated at our institution. 34 (9.6%) experienced recurrence at a median of 18.3 months following treatment completion. 32 (94.1%) had HPV 16/18 subtype driven tumors. Median post-recurrence survival was 19.9 months and 18 (53%) of the 34 are alive. 14 patients (41.2%) experienced locoregional failure and had a median post recurrence survival of 25.1 months, 17 patients (50%) experienced distant metastases and had a median post recurrence survival of 23.6 months, and 3 patients (8.8%) experienced both local and distant failure with a median post recurrence survival of 31.7 months. Elderly patients over age 70 had a median post-recurrence survival of 13.9 months versus 22.6 months in those younger. Patients who experienced visceral organ (10.8 months), brain (12.3 months), bone (10.5 months) or multiple distant sites of metastases (12.3 months) all experienced poor post-recurrence survival. Patients with local failure who were treated with both initial and salvage radiation therapy (10 patients) had a median post-recurrence survival of 22.6 months. Salvage regimens can be found in Table 1.

Conclusion: This is one of the largest series to date evaluating survival following failure in HPV derived OPC. In this population, long term survival and durable remission are possible. Local failure in the radiation field does not necessarily confer a poor prognosis and can be salvaged with regimens including re-irradiation. Age of patients and location of distant metastases can be used to prognosticate those with recurrence. Table 1- Salvage Treatment Regimens of Recurrent HPV Driven Oropharyngeal Cancers
Failure Location RT Alone Chemo Alone Surgery Alone Chemo + RT Chemo + Surgery RT+ Surgery Chemo + RT + Surgery No Salvage
Locoregional 1 0 0 2 2 3 6 0
Distant Metastases 1 6 1 3 3 0 2 1
Locoregional and Distant Metastases 0 0 0 2 1 0 0 0

Author Disclosure: W. Su: None. B. Barber: None. B. Miles: None. K. Misiukiewicz: None. R.L. Bakst: None.

William Su, BA

Disclosure:
No relationships to disclose.

Presentation(s):

Send Email for William Su


Assets

230 - Long Term Outcomes in Patients With Recurrent HPV-Related Oropharyngeal Cancer



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Long Term Outcomes in Patients With Recurrent HPV-Related Oropharyngeal Cancer