Combined modality treatment for stage IV squamous cell carcinoma of the oropharynx

Abstract

5609 Background: Traditional tx for locally advanced squamous cell carcinoma [SCC] of oropharynx [OPX] has been oncologic resection + adjuvant RT. In recent years, organ preserving therapy with chemoradiation [CRT] has emerged. This study compares outcomes of patients (pts) treated with these combined modalities [CM]. Methods: 1998–2001: 30 pts with Stage IV SCC of OPX were judged by our Multi-disciplinary Head & Neck Tumor board to be candidates for definitive CM and given choice of either: 1) Concurrent Taxol or Cisplatin based CRT or 2) Composite resection, neck dissection & adjuvant RT [SRT]. Results: 14 received CRT (11 Taxol and 3 Cisplatin): 7(50%) tonsillar fossa (TF) and 7(50%) base of tongue (BOT): 8T3, 6T4, 2N0, 1N1, 3N2a, 1N2b, 3N2c, and 4N3. Med RT 70 Gy. 7 reqd RT break (Mean 3 days). 8(57%) reqd PEG during RT and 3(21%) 1-year post-RT. 1 pt developed osteoradionecrosis of the maxilla. There were 3(21%) with locally persistent disease post-tx, 1(7%) LR and 4(29%) DM. 6(43%) alive with no evidence of disease (NED), 2(14%) alive with disease (AWD), 5(36%) dead of disease (DOD), and 1(7%) dead of intercurrent disease (DID). 16 received SRT: 12(75%) TF and 4(25%) BOT, of clinical stage: 11T1, 5T4, 1N0, 1N1, 6N2a, 5N2b, 1N2c, and 2N3. Margins: 12 neg, 1 close, and 3 pos. 15 had flap reconstruction. Med RT 60 Gy. 6 reqd RT break (Mean 3.5 days). There were 2 fistulas and 2 hardware infections. 4 (25%) reqd PEG during RT, and 1 at 1 year post-RT. There were 2(13%) LR and 2(13%) DM. 10(63%) NED, 4(25%) DOD, 1(6%) DID, and 1 lost to f/u. Med f/u 135 wks. Med KPS 80. Time to med overall survival (OS) has not been reached. Kaplan-Meier projected 3-year analysis showed no stat difference between CRT and SRT, with regards to: OS 56% vs 59% (p=0.58), Progression-free survival 45% vs. 65% (P=0.15), DM-free survival 56% vs. 77% (p=0.18) or Local control 71% vs. 86% (p=0.30), respectively. For those DOD, med time to death was 45 weeks post-RT. Of the 12 requiring PEG during RT (40%), 8 were BOT. BOT reqd PEG during RT more frequently compared with TF (73% vs. 21%). Conclusions: In our series of Stage IV SCC OPX, there was no stat difference in 3-year outcomes between CRT and SRT in terms of OS, PFS, DMFS, and LC. Tx with CM is tolerable in pts with good KPS. BOT tumors reqd PEG more frequently. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration MedImmune