Patterns of Distant Failure and Second Primary Cancers in Patients with Oropharyngeal Squamous Cell Carcinoma: Implications for Surveillance Methodology

Abstract

Background: We analyzed the pattern of distant metastasis (DM) and secondary primary cancers (SPC) in patients with oropharyngeal squamous cell carcinoma (OPSCC) to develop surveillance guidelines. Methods: A retrospective review of 177 patients with OPSCC treated with intensity modulated radiation therapy ± chemotherapy between 2002 and 2012 was performed to characterize the rate, pattern, and timing of DM and SPC. Results: Sixteen patients (9.0%) developed DM and 9 patients (5.1%) developed a SPC. Overall, 24/177 patients (13.6%) developed a DM and/or SPC for a total of 27 events. 92.6% (25/27) of events were detectable on physical exam and/or chest CT. p16+ patients developed DM later than p16- tumors (23.4 months versus 8.7 months). Conclusions: Chest CT with physical examination detects the majority of DM and SPC in patients with OPSCC and would provide effective surveillance in these patients. A risk adapted surveillance strategy is proposed.