Among patients suffering post-radiation or chemoradiation locoregional head and neck squamous cell carcinoma (HNSCC) recurrence, those with human papillomavirus (HPV)-positive disease have better survival rates, while those with oral cavity carcinomas fared worse, according to a single-institution cohort study of 1000 patients published in JAMA Oncology.1
Tumor expression of the p16 (cyclin-dependent kinase inhibitor 2A) suppression protein also had longer survival times prior to metastasis, and a subset of patients with solitary oligometastasis survived longer than other patients with metastatic HNSCC.
Between 15% and 50% of patients with HNSCC suffer tumor recurrence.
To assess patterns and correlates of treatment failure and patient survival following HNSCC recurrence among patients who had undergone intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy, the authors conducted this single-institution cohort study.
Among 186 women and 814 men treated for stage III to IVB HNSCC between 2001 and 2013, locoregional failure rates were higher for patients with oral cavity carcinomas than those with oropharyngeal carcinomas (hazard ratio [HR] 5.2; 95% CI, 3.1-8.6; P < .001) or tumor subsites.
Oral cavity carcinomas were also associated with worse survival following metastasis to distant sites (HR 3.66; 95% CI, 1.98-6.80; P < .001).
“Patients with oropharyngeal carcinoma positive for human papillomavirus or p16 lived longer after locoregional failure compared with patients with oropharyngeal carcinoma negative for human papillomavirus or p16” prior to metastasis, the authors noted. Median survival was 36.5 months vs 13.6 months (P = .007) but this association was not found among patients suffering distant metastasis.
“Salvage surgery was associated with improved overall survival [OS] following locoregional failure (HR 0.51; 95% CI, 0.34-0.77; P = .001); oligometastatic disease (1 vs ≥2 lesions; HR 0.32; 95% CI, 0.16-0.63; P = .001) was associated with improved overall survival following distant metastasis,” they concluded.
- Leeman JE, Li JG, Pei X, et al. Patterns of treatment failure and postrecurrence outcomes among patients with locally advanced head and neck squamous cell carcinoma after chemoradiotherapy using modern radiation techniques. JAMA Oncol. 2017 May 25. doi: 10.1001/jamaoncol.2017.0973 [Epub ahead of print]