Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy

Heather Warkentin,Sunita Ghosh,Matthew Parliament,Rufus Scrimger,Robyn Banerjee,Naresh Jha,Brock J Debenham

doi:10.7759/cureus.713

Abstract

PurposeTo compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy.Methods and materialsTwo hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review.ResultsOne hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status.ConclusionsOur analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.

Highlights

Advanced oropharyngeal cancers are increasing in incidence
Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston comorbidity score (CCI)
Our analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy

Summary

Introduction

Advanced oropharyngeal cancers are increasing in incidence. most centers throughout Canada and the United States (US) favor treating these malignancies with an organpreservation approach using combined chemoradiotherapy (CRT) [1], some centers, including ours, have a large experience treating with primary surgery followed by adjuvant therapy [2]. Our center reported outcomes of our experience from the years 1998 to 2009, which appeared to show an improved disease-free survival at two years for surgery as a primary treatment compared to CRT (73.7% vs 57.4%) [2]. Previous studies from Stanford and others have consistently reported three to four-year local control rates for patients treated with CRT of 90% or higher, and three-year disease-free survival rates of approximately 80% [3,4,5,6,7,8]. Due to the large discrepancy in our outcomes compared to other large academic centers, we undertook a quality assurance study looking at stage-matched patients with locally advanced oropharyngeal cancer undergoing either primary surgery or radiotherapy with an emphasis on disease-free survival, overall survival, and patterns of recurrence

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