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Primary surgery results in no survival benefit compared to primary radiation for oropharyngeal cancer patients stratified by high-risk human papilloma virus status.
- Source :
-
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2017 Jan; Vol. 274 (1), pp. 477-487. Date of Electronic Publication: 2016 Aug 04. - Publication Year :
- 2017
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Abstract
- We changed the primary oropharynx squamous cell carcinoma (OPSCC) treatment recommendation from primary radiation therapy (RT) to tumor surgery and neck dissection, followed by RT around the year 2000 with apparently improved survival. However, high-risk human papilloma virus (hr-HPV)-16-caused OPSCCs have increased during this period. Furthermore, hr-HPV+ OPSCC carry a better prognosis than hr-HPV-negative patients. We have, therefore, evaluated the 5-year survival in the period from 1992 to 1999 versus 2000 to 2008 stratified by hr-HPV tumor infection status. Ninety-six OPSCC patients were treated from 1992 to 1999 compared with 136 patients from 2000 to 2008. The 5-year disease-specific survival (DDS) and overall survival (OS) were recorded, while the health-related quality of life (HRQoL) scores were obtained from some of the cured patients. Thirty-eight (40 %) in the first period and 86 OPSCCs (63 %) in the second period were hr-HPV+. In the first period, 16 versus 62 patients in the last period were treated by neck dissection, primary tumor surgery, and RT. DSS among all the hr-HPV-negative patients in the first period was 51 versus 55 % in the second period, and the corresponding OS was 33 versus 31 %, respectively. The DSS among all the hr-HPV+ patients was 78 % in the first period versus 77 % in the second period, while the OS was 71 versus 69 %, respectively. The HRQoL scores among successfully treated patients were worse following surgery, plus RT than RT only. The hr-HPV-adjusted 5-year survival in OPSCC patients was similar between the two time periods. A decreased HRQoL was associated with surgical therapy, which indicates that hr-HPV+ OPSCC patients may be treated by primary RT followed by major surgery only if RT treatment fails.
- Subjects :
- Aged
Carcinoma, Squamous Cell virology
DNA, Viral isolation & purification
Disease-Free Survival
Female
Humans
Male
Middle Aged
Neck Dissection
Oropharyngeal Neoplasms virology
Papillomaviridae genetics
Prognosis
Quality of Life
Carcinoma, Squamous Cell mortality
Carcinoma, Squamous Cell therapy
Oropharyngeal Neoplasms mortality
Oropharyngeal Neoplasms therapy
Papillomavirus Infections diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1434-4726
- Volume :
- 274
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 27491318
- Full Text :
- https://doi.org/10.1007/s00405-016-4203-2