Optimising management approaches for locally advanced oropharyngeal squamous cell carcinoma (LAOPSCC): A retrospective review of prognostic factors and outcomes in an Asian tertiary institution.

Abstract

e16022 Background: LAOPSCC is treated with concurrent chemotherapy and radiation (CRT). However, certain subsets of OPSCC may have favourable prognoses, thus raising the question if all patients require similar CRT. This study aims to identify prognostic factors in Asian LAOPSCC and explore patient outcomes according to treatment modality and chemotherapy type. Methods: A retrospective review of resectable LAOPSCC from 2001-2006 were included in this analysis. Patient demographics, risk factors, treatment modalities were collated. Results: Out of the 130 patients, 87 received CRT, 24 received RT alone whilst 19 underwent surgery followed by adjuvant therapy. 74% of the patients were male with median age of 60. 30% were non-smokers. Median OS was 5.2 years. Univariable cox regression analysis showed that older age, male gender, smokers, history of alcohol consumption, higher cancer stage, higher T-stage, base of tongue tumors, higher Charlson Comorbidity Index (CCI) and low albumin were associated with worse overall survival (OS), progression free survival (PFS) and local relapse- free survival (LRFS). After multivariate analysis, smoking status, CCI scores and cancer stage were independently prognostic for OS. Patients who received RT alone, despite being older, predominantly smokers and having higher CCI, had similar OS, PFS and LRFS compared to CRT: Hazard Ratio (HR) 1.7, p=0.2; HR 1.7, p=0.1 and HR 1.6, p=0.2 respectively on multivariable cox regression analysis. In an exploratory analysis, after adjusting for age, CCI, smoking status and cancer stage, patients who received cisplatin-based CRT (n=70) had superior overall survival compared with RT alone (HR=0.4, p=0.01). However, patients who received non-cisplatin-based CRT (n=17) had similar overall survival compared to RT alone, independent of age, CCI, smoking status and cancer stage (HR=1.5,p=0.3). Conclusions: Asian LAOPSCC consists of a significant proportion of non-smokers and females. Amongst Asian LAOPSCC, cisplatin-based CRT remains the standard of care. In patients unfit for cisplatin-based treatment, RT alone should be considered.