Carcinoma Of Oropharynx Research Articles

CO4.2 - Cost-effectiveness of an adaptive radiotherapy strategy to decrease xerostomia in locally advanced oropharynx carcinoma: An economic evaluation alongside the ARTIX Randomized Clinical Trial matched to the French National Health Insurance Database

CO4.2 - Cost-effectiveness of an adaptive radiotherapy strategy to decrease xerostomia in locally advanced oropharynx carcinoma: An economic evaluation alongside the ARTIX Randomized Clinical Trial matched to the French National Health Insurance Database

Is locally advanced head and neck cancer ‘increasing’ in the Netherlands? The paradox of absolute numbers, standardized incidence rates and proportional share

BackgroundSeveral reports have indicated that locally advanced head and neck cancer (LAHNC) has increased in the past decade. However, incidence trends cannot be easily compared because slightly different definitions of LAHNC were used. AimTo investigate if the incidence of locally advanced disease (LAD) in the oral cavity, oropharynx, hypopharynx and larynx is indeed increasing over time, considering the growing and ageing population in the Netherlands. Patients and methodsData were obtained from the Netherlands Cancer Registry (NCR). Primary head and neck squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx diagnosed between 1989 and 2017 were included. Yearly numbers and European standardized incidence rates (ESRs) were reported by extent of disease. The annual percentage change (APC) over time in ESRs was calculated to assess trends. ResultsAbsolute numbers and ESRs of LAD increased over time for oral cavity and most prominently for oropharynx carcinomas (before 1996, APC: 0.4, 95%CI: 0.1; 0.8 and APC: 5.7 (95%CI: 3.1; 8.4) after 1996: 1.5 (1.0; 2.0) respectively. For hypopharynx cancer the absolute number and ESR of LAD increased until 1997 and declined with 0.8% per year since 1997. Absolute numbers of patients with larynx cancer stayed stable over time, while ESR decreased (APC: −0.8 (95%CI: −1.1; −0.6)). ConclusionThe perception of an increasing trend in LAD in the Netherlands can be attributed to the increasing incidence of oral cavity and oropharynx carcinomas. For LAD of the hypopharynx a decreasing trend was observed. In larynx cancer, the proportional share of LAD of the larynx increased, even though incidence rates declined.

Head and neck cancer: hypofractionated adjuvant radiation therapy

INTRODUCTION: Effect of adiuvant radiation therapy (RT) on oncologic outcomes is well-known and confirmed by different trials. Optimal time to start RT is 6–8 weeks after surgery. Increasing duration of RT delay beyond that interval leads to decrease in overall survival (OS) and makes loco-regional recurrence (LRC) more probable. However, more than 50% patients do not receive adjuvant treatment in time (Mitra S. et al., 2022). Overall treatment time (77–100 days) is another factor that influences effectiveness of adjuvant RT. In order to keep within that time limits non-conventional regimens of RT can be used.OBJECTIVE: To test safety and feasibility of hypofractionated adjuvant RT in patients with locally advanced squamous cell carcinoma of oral cavity and oropharynx.MATERIALS AND METHODS: Patients with stage III–IV squamous cell carcinoma of oral cavity and oropharynx (n=11) who underwent surgery and have to recieve adjuvant RT in 8 weeks and more after surgery are included. Dose was delivered using Volumetric Modulated Arc Therapy (VMAT) and simultaneous integrated boost.RESULTS: Patients (n=11) completed RT successfully. Surgery-to-RT interval ranges between 9 and 15 weeks. Dose per fraction on high-risk-CTV varies between 2,5 and 2,75 Gy. Acute side-effects (oral mucositis grade II) presented after 27–32 Gy (11–13 fractions) in 9 patient out of 11 and reached maximum (oral mucositis grade III, radiation dermatitis grade II) at the end of the treatment.CONCLUSIONS: Hypofractionated adjuvant RT (VMAT) can be safely used in patients with locally advanced squamous cell carcinoma of oral cavity and oropharynx and local acute toxicity can be controlled.

Changes in Body Mass Index Are Associated with Squamous Cell Carcinomas of Oral Cavity, Oropharynx and Larynx: A Case-Control Study in Brazil

Head and neck cancer (HNC) significantly impacts nutritional status because the tumor limits swallowing function. In this sense, it is important to monitor the nutritional status throughout the life of any individual. A multicenter case-control study was carried out to analyze the BMI at 30 years of age, two years before diagnosis and at the time of diagnosis of individuals with oral cavity, oropharynx, and larynx cancers. It was observed that a 5% reduction in BMI during the two years before enrollment was associated with an increased risk of the oral cavity (OR = 3.73), oropharyngeal OR = 5.25), and laryngeal (OR = 5.22). Reduced BMI of more than 5% over two years before diagnosis was associated with HNC. Weight loss remained significant at diagnosis, but it is not possible to exclude reverse causality since most cases are at an advanced stage. BMI monitoring of individuals at potential risk for HNC can promote early diagnosis and nutritional interventions for HNC.

Comparison of different treatments for HPV+ oropharyngeal carcinoma: a network meta-analysis.

Treatment of human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is rapidly evolving. Despite either surgery or radiotherapy (RT), with or without chemotherapy (CT), being acceptable in intermediate and locally advanced diseases, there is uncertainty regarding the best treatment option for these patients. Therefore, we performed a network meta-analysis (NMA) to compare the relative efficacy of different treatments for HPV+ oropharyngeal carcinoma. Randomized clinical trials that enrolled adults with non-metastatic HPV+ oropharynx cancer and provided data about overall survival (OS) and/or progression-free survival (PFS) and/or locoregional control and distant metastases (LRC and DM) were included. Fixed- or random-effects models were fit using a Bayesian approach to NMA. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (CrIs). The primary outcome was OS. A total of 844 citations were screened; 11 randomized clinical trials were included (HPV+ stage III-IV cancer, mainly oropharynx carcinomas). Nine treatment arms were compared. Radiotherapy (altered or standard fractionation) + triweekly cisplatin (HR 3.8; 95% CrIs 0.29-65 and 0.3; 95% CrIs 0.03-2.51) was superior to RT in term of OS (P score = 0.42 and 0.16). Radiotherapy with low and high cisplatin doses appeared similar (HR 1.57; 95% CrIs 0.19-12.72). Altered fractionation or standard RT + 3-weekly cisplatin are the 2 highest-ranked options in terms of PFS (P score = 0.35 and 0.34). This meta-analysis confirms the role of cisplatin added to RT as the best option for HPV+ oropharyngeal carcinoma. RT+ 3-weekly cisplatin is likely to be the best radical treatment in terms of OS and PFS.

Prognostic Significance of STING Immunoexpression in Relation to HPV16 Infection in Patients with Squamous Cell Carcinomas of Oral Cavity and Oropharynx.

Infection with HPV16 in cancers of the oral cavity (OCSCC) and oropharynx (OPSCC) is, today, an important etiological and prognostic factor. Patients with HPV-positive OPSCC have a better prognosis than uninfected patients. However, in over 40% of these patients, cancer progression is noticed. Their identification is particularly important due to the ongoing clinical trials regarding the possibility of de-escalation of anticancer treatment in patients with HPV-positive OPSCC. Some studies suggest that there is possibility to differentiate prognosis of HPV16-positive patients by STING (Stimulator of Interferon Genes) immunoexpression. The aim of the present study was to analyze the influence of STING immunoexpression on overall (OS) and disease-free survival (DFS) of patients with HPV16-positive and -negative OCSCC and OPSCC. The study was performed in a group of 87 patients with OCSCC and OPSCC for which in our earlier study active HPV16 infection was assessed by P16 expression followed by HPV DNA detection. To analyze STING immunoexpression in tumor area (THS) and in adjacent stromal tissues (SHS) H score (HS) was applied. In the subgroup with HPV16, active infection patients with tumors with THS had significantly better DFS (p = 0.047) than those without THS. In this subgroup, TSH did not significantly influence OS, and SHS did not significantly correlate with OS and DFS. In the subgroup of patients without active HPV16 infection, THS and SHS also did not significantly influence patients’ survival. Presented results indicated prognostic potential of tumor STING immunoexpression in patients with active HPV16 infection in cancers of oral cavity and oropharynx.

Long term outcome and late toxicity Of SIB-IMRT in definitive management of head and neck cancers in patients not suitable for chemo-radiotherapy.

To evaluate efficacy and late toxicity of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) in definitive management of head-and-neck cancers. In this prospective interventional study, histological proven squamous cell carcinoma of oropharynx, hypopharynx, or larynx with stage T1-3 N0-3 M0 who were not candidates for concurrent chemotherapy were treated with IMRT-SIB with radical intent. Doses prescribed for IMRT-SIB to meet the clinical needs of nodal volumes were either SIB-66 schedule 66 Gray (Gy) prescribed to high risk (HR) planned target volume (PTV), 60 (Gy) to intermediate risk (IR) PTV and 54 Gy to low risk (LR) PTV in 30 fractions or SIB-70 schedule 70 Gy to PTV-HR, 59.4 Gy to PTV-IR and 56 Gy to PTV-LR in 33 fractions. Forty-five patients were included. Forty-two patients were treated with SIB-66 schedule and three patients with SIB-70 schedule. The median follow-up period was 21 (6-68) months. There was residual disease in three patients. Recurrence was observed in 24 patients. Most recurrences were in HR volume (n = 19) and three patients had distant failure. Estimated 2-year locoregional control, disease-free survival, and overall survival were 55.55%, 49.7%, and 51.1%, respectively. Grade 3 late skin toxicity, subcutaneous fibrosis, and xerostomia were observed in three patients. Efficacy and late toxicity of IMRT-SIB observed in our study suggest it as a suitable treatment option for patients who are not fit for chemoradiation.

Impacts of hepatitis b infection in patients with head and neck squamous carcinoma.

e18051 Background: Hepatitis B Virus (HBV) infection was known to be have impacts of occurrence and survival in different malignancies. We aim to evaluate the clinical association with head and neck squamous cell cancer (HNSCC) and HBV infection. Methods: A retrospective review was conducted on the medical records and cancer registry database at the Taichung Veterans General Hospital (Taichung, Taiwan) between January 2007 and December 2015. Patients with histologically proven squamous cell carcinoma of oral cavity, oropharynx, hypopharynx and larynx were enrolled in the study. HBV infection was defined as HBsAg seropositivity. Clinical features, hepatic function test and five-year overall survival (OS) were compared between patients with and without HBV infection. Results: A total of 1826 HNSCC patients were analyzed. 225 of them (12.3%) were proved HBV-infected. The HBV-infected patients was diagnosed at younger age (< 65 years; 76.1% vs. 65.5%, p< 0.012) and had a higher proportion of initial liver cirrhosis (11.6% vs. 3.6%, p< 0.001) and hepatic dysfunction (10.7% vs. 6.1%, p= 0.009) included elevation of alanine transaminase (ALT), aspartate transaminase (AST) and prothrombin time expressed as international normalized ratio (INR). The other baseline characteristics were similar. The five-year OS were 52.9% and 48.6% in the HNSCC patients with or without HBV infection, respectively ( p= 0.341). The incidence of later founded hepatic dysfunction during follow-up was similar (31.1% vs 26.2%, p= 0.122). Conclusions: Information from this study indicated that HBV-infected HNSCC patients may present in younger age, more initial liver cirrhosis, and hepatic dysfunction. However, HBV infection did not have negative impacts on survival outcome and later founded hepatic dysfunction in those patients. Characteristics and survival of HBsAg (+) vs. HBsAg (-) HNSCC Patients[Table: see text]

Recurrence pattern with respect to two different dose fractionations in patients with locally advanced head and neck cancer treated with chemoradiation using image-guided volumetric arc therapy.

Patients with head and neck cancer were treated with either 70 Gy in 35 fractions (Arm A) or 66 Gy in 30 fractions (Arm B). Total 168 patients of carcinoma oropharynx, larynx, and hypopharynx treated with radical chemoradiation in two Arm A versus B (65 vs. 103 patients). With a median follow-up of 16 months (0-67), 2year disease-free survival (DFS) and overall survival (OS) was 56.3% versus 62.1% (p=0.64) and 44.5% versus 53.0% (p=0.51) in Arm A versus B. Total 22 (33.8%) versus 28 (27.2%) failed locoregionally. Majority of failures were infield for both primary (17 vs. 23 cases) and nodes (13 vs. 12) in Arm A versus B. Ten (71.4%) vs. 10 (76.9%) had nodal failure in index nodal level only. Commonly seen failure in head-neck radical chemoradiation is within infield high-risk volume, nodal failure being most common in index nodal level.

A clinicopathological study of squamous cell carcinoma of oral cavity and oropharynx in non-smoker and non-drinker patients

<p class="abstract"><strong>Background:</strong> To describe the clinicopathological variables of the Squamous cell carcinoma (SCC) of oral cavity and oropharynx in non-smoker and non-drinker patients (NSND).</p><p class="abstract"><strong>Methods: </strong>A retrospective review of thirty NSND patients with proven SCC of oral cavity and oropharynx in ENT department at Government Medical College Patiala. Data collected included demographics, aetiological factors, site, symptoms, nodal metastasis, histopathological grading and TNM staging at presentation.</p><p class="abstract"><strong>Results:</strong> In oral cavity cancers, patients presented commonly in 4th decade whereas in oropharynx, commonly in 6th decade. NSND patients were more likely to be female, male female ratio being 43:56. In NSND women, 82% had oral cavity SCC and 18% had oropharyngeal SCC. 13% of NSND patients reported sharp tooth, 10% reported regular environmental exposure, and 10% reported occupational exposure followed by lichen planus (6.67%). In oral cavity SCC, maximum incidence was that of oral tongue (59.1%) and in oropharyngeal SCC, base of tongue (62.5%) was most commonly involved. Overall, well differentiated SCC predominated in both oral cavity and oropharyngeal carcinoma in our study. In oral cavity SCC, maximum patients presented in early tumor staging i.e T1 and T2 (81.8%) and early overall staging (stage I and II).In oropharyngeal SCC, maximum patients presented in advanced tumor staging i.e T3 and T4 (62.5%) and advanced overall staging (stage III, IV).</p><p><strong>Conclusions:</strong> In NSND patients, potential factors like sharp tooth, environmental smoke, occupational exposure and lichen planus may contribute to SCC in oral cavity and oropharynx.</p>

The Prognostic Impact of Radiotherapy Delays in Oropharynx Carcinoma and the Role of p16 Status.

A retrospective analysis was performed to evaluate the prognostic significance of treatment delays (TDs) for oropharynx carcinoma patients treated with definitive radiotherapy (RT), comparing p16+ versus p16- disease. Patients treated between 2012 and 2016 were analyzed (n=763). TD was defined as the time from pathologic diagnosis to initiation of RT. TD thresholds of ≤60, 61 to 90, and >90 days were used to stratify outcomes. Time on treatment (TOT) delays were estimated based on the RT fractionation. TOT delay of 1 to 3 days was compared with >3 days. Predictors of cancer-specific survival (CSS) and locoregional recurrence (LRR) were evaluated on multivariable analysis. Six hundred fifty (85%) patients had p16+ disease. On multivariable analysis, TOT delay of 1 to 3 days versus <1 day was associated with inferior CSS (hazard ratio [HR]=1.81; 95% confidence interval [CI]: 1.02-3.22). TD >90 versus ≤60 days (HR=1.68; 95% CI: 0.98-3.04) and 61 to 90 versus ≤60 days (HR=0.94; 95% CI: 0.60-1.48) was not associated with CSS. TD >90 versus ≤60 days (HR=1.29; 95% CI: 0.66-2.52), TD 61 to 90 versus ≤60 days (HR=0.98; 95% CI: 0.64-1.52), TOT 1 to 3 versus <1 day (HR=0.91; 95% CI: 0.39-2.11), and TOT >3 versus <1 day (HR=1.79; 95% CI: 0.80-3.99) were not associated with LRR. There was no interaction between p16 status and TD in relation to LRR (P=0.27) or CSS (P=0.17). TDs were not significantly associated with CSS or LRR. TOT of 1 to 3 days was associated with inferior CSS. p16 status should not be a significant factor when triaging RT start dates.

Nanog expression in patients with squamous cell carcinoma of oropharynx in relation to immunohistochemical score.

This study aimed to compare prognostic potential of Nanog expression analysed by three immunohistochemical scores in the group of 63 squamous cell carcinomas of oropharynx. Immunoreactivity of Nanog expression was analyzed by semiquantitative score, immunoreactive score and H-score. For all three scores, the cut-off points for Nanog overexpression and its lack, allowing for optimal separation of overall and disease free survival curves, were search by minimal p-value method. In semiquantitative score, the best separation of overall and disease free survival curves was obtain by cut-off point lack of staining vs. week/moderate/strong staining, although statistical significance was not reach (OS: HR = 1.016, p = 0.081, DFS: HR = 6.876, p = 0.061). The cut-off points for immunoreactive score and H-score were, respectively: 1 (OS: HR = 6.977, p = 0.014, DFS: HR = 6.002, p = 0.019) and 50 (OS: HR = 6.977, p = 0.014, DFS: HR = 6.002, p = 0.019). The cut-off points found for these two scores allow to identify the same subgroups of patients with lack of Nanog expression (11.1%) and its overexpression (88.9%). All patients with tumors characterized by lack of Nanog overexpression identifying by immunoreactive score and H-score survived 5 years without evidence of cancer progression. In multivariate analysis Nanog immunoreactivity analysed by QRS and IRS was independent prognostic factor for OS (HR = 10.195, p = 0.024). Immunohistochemical score using to distinguish Nanog overexpression or its lack has influence on prognostic potential of this biomarker.

Correlation of PD-L1 expression with toxicities and response in oropharyngeal cancers treated with definitive chemoradiotherapy.

The programmed death receptor ligand 1 (PD-L1) is a cell-surface glycoprotein expressed in tumour cells (TCs) and is also upregulated in tumour infiltrating lymphocytes. The effect of PD-L1 expression on TCs and tumour-infiltrating lymphocytes (TILs) on acute radiation toxicity and response in oropharyngeal squamous cell carcinoma treated with concurrent chemoradiotherapy is less known. Squamous cell carcinoma of oropharynx with stage II-IVA (AJCC 8th) were recruited in this prospective observational study. Definitive radiation therapy (RT) of 70 Gray in 35 fractions at 2 Gray per fraction, 5 fractions a week in 2 phases was delivered with concurrent chemotherapy (cisplatin 40 mg/m2 weekly). Patients were assessed weekly for acute toxicities with Radiation Therapy Oncology Group criteria. Response assessment was done at 3 months post RT according to World Health Organization response assessment criteria. The programmed death receptor ligand 1 expression in TCs and TILs was correlated with acute toxicity and survival. Of 51 patients, 20 (39.2%) had PD-L1 expression in TCs and 18 (35.3%) in TILs. Patients with PD-L1 expression in TCs had fewer grade ≥ 3 oral mucositis (25% vs. 58%; p = 0.02) and grade ≥ 3 dysphagia (25% vs. 55%; p = 0.046). The programmed death receptor ligand 1-tumour infiltrating lymphocytes positives had lower ≥ 3 grade oral mucositis (22% vs. 58%; p = 0.02) and ≥ 3 grade dysphagia (17% vs. 58%; p = 0.007). Two-year overall and progression-free survival rate for the PD-L1-tumour-positive vs. PD-L1-tumour-negative group was not different (p > 0.5). Positive PD-L1 expression is associated with fewer acute radiation toxicities, and this could be used as a potential biomarker.

A comparative study of planning and dosimetry in locally advanced head-and-neck cancer: sequential versus simultaneous integrated boost methods in intensity-modulated radiotherapy

Objective: A head-and-neck cancer (HNC) comprises one-third load of India’s cancer burden. We aim to compare the target coverage and the normal tissue sparing between sequential intensity-modulated radiotherapy (IMRT) and simultaneously integrated boost (SIB)-IMRT plan for patients of locally advanced HNCs. We evaluate dosimetric parameters of two plans for a single patient and compare target coverage and conformity index (C. I.) and also assess the differences in dose received by organs at risk (OAR) by two plans. Materials and Methods: After recording the detailed history, performing a thorough clinical examination and the relevant investigations, the patients who were staged as locally advanced squamous cell carcinoma of oropharynx, hypopharynx, and supraglottic regions were chosen for the study. An informed consent was taken before enrolling them in study. Results: A total of 30 patients were enrolled in the study. Three patients were female, whereas the remaining 27 were male. Of the 30 patients 19 patients (63.34%) had oropharyngeal disease and 11 had hypopharyngeal disease (36.66%). The present study reported that 24 patients had moderately differentiated squamous cell carcinoma, two patients had well differentiated tumor, and in four patients, it was poorly differentiated carcinoma. The minimum dose, maximum dose, and the mean dose volumes of planning target volume (PTV) 1 and PTV2 which were designated as D100, Dmax and Dmean, respectively, were analyzed by both SIB and SEQ-B IMRT plans. The C. I. was derived by Radiation Therapy Oncology Group (RTOG) 90-05 (34). The C. I. for PTV1 and PTV2 by SEQ-B and SIB IMRT plans was 0.96 versus 0.95 and 0.97 versus 0.95, respectively. The mean maximum dose to brain stem was 4230.02 cGy with SEQ-B and 4305.52 cGy with SIB plan. On analyzing the mean maximum dose received by mandible, a statistically significant sparing was seen with SIB technique. Conclusion: In the present study, as no significant difference was observed in OAR sparing except mandible in both the plans. Hence, in view of the results and comparative studies, both the plans are clinically acceptable, although taking into account the tumor coverage, the sequential boost IMRT plan arm gave better results.

Primary small cell neuroendocrine carcinoma of oropharynx: A potential diagnostic pitfall with Human papillomavirus (HPV)-related squamous cell carcinoma

Abstract Introduction/Objective Small cell neuroendocrine carcinoma (SCNEC) primary to the head and neck region, especially from oropharynx, is very rare. Published data have shown that Human papillomavirus (HPV) positivity may be associated with a better overall survival in these tumors. Here we report a case of p16 positive SCNEC arising from the tonsil. Methods/Case Report A 51-year-old man with former smoking history was evaluated for sore throat and difficulty swallowing. Nasopharyngolaryngoscopy showed a left tonsillar mass and imaging revealed left jugular chain lymphadenopathy with no other evidence of a primary tumor elsewhere, including the lung. Biopsy of the mass was performed which revealed nested proliferation of uniform, hyperchromatic tumor cells with scant cytoplasm, indistinct nucleoli, areas of nuclear molding, and brisk mitotic activity. No keratinization was present, but a vague peripheral palisade was seen in some of the nests. The major differential diagnostic considerations included HPV-related nonkeratinizing squamous cell carcinoma, basaloid squamous cell carcinoma, and SCNEC. Immunohistochemistry revealed tumor cells were positive for AE1/AE3 with partial dot-like perinuclear pattern, cytokeratin 8/18, synaptophysin, and strong p16; negative for P40, P63, cytokeratin 5/6, cytokeratin 7, chromogranin, and CD56. Because SCNEC at any site may be positive for p16, testing for HPV RNA by in-situ hybridization was performed and showed negative for HPV subtypes 6, 11, 16, and 18. Results (if a Case Study enter NA) NA Conclusion This case highlights the differential diagnosis of a “basaloid” appearing carcinoma in the oropharynx. It also reinforces the fact that although p16 is considered a reliable surrogate marker for HPV infection in oropharyngeal squamous cell carcinoma, the same does not hold true for SCNEC.

Clinical Outcomes and Toxicity Profile With IMRT or Brachytherapy Boost in Oropharyngeal Malignancies: A Randomized, Open Label Study

Radical radiation therapy in oropharyngeal malignancies have a significant toxicity especially in relation to dose to dysphagia aspiration related structures (DARS), mucositis and aspiration which leads to prolonged overall treatment times, thereby, having an impact on survival outcomes. Interstitial Brachytherapy (ISBT) has significant role in reducing these toxicities, however, literature comparing Intensity modulated radiation therapy (IMRT) with Brachytherapy boost is lacking. Our study looks into the clinical outcomes and toxicity profile while comparing the two treatment modalities.A total of 70 patients diagnosed histopathologically as squamous carcinoma of oropharynx were randomized to receive radical radiation therapy with IMRT (n = 35) or IMRT with ISBT boost (n = 35). The total dose with IMRT was 70Gy and in ISBT, initial dose was 50Gy with IMRT followed by 24.5Gy dose (3.5Gy in 12 fractions). Patients were followed up as per institute protocol and assessed for a median follow-up of 36 months. Assessment of survival outcomes in terms of progression free survival (PFS) and overall survival (OS) were assessed. Toxicity profile was assessed as per CTCAE 4.0 criteria and quality of life was assessed as per EORTC-C30 and HN35 questionnaires. Dosimetric parameters for the target volumes were compared along with assessment of various important organs at risk (OAR).After a median follow up of 36 months, PFS was 86% vs 81% favoring ISBT arm (P = 0.032), however, there was no difference in overall survival. On assessment of toxicities, dysphagia and xerostomia were significantly reduced with ISBT boost with Grade II and III toxicities 12% and 18% vs 18% and 24% respectively. On QoL assessment, physical (P < 0.001) and social functioning (P = 0.012) favored ISBT boost. On symptom assessment, fatigue, dyspnea, appetite loss, speech problems, swallowing and pain was significantly reduced with ISBT boost. Dosimetric parameters showed significant dose reduction to DARS (P < 0.001) and parotid glands (P < 0.001) with ISBT boost.ISBT boost has shown to be effective in improving PFS, toxicity profile and quality of life outcomes in oropharyngeal malignancies in spite of technological advancements in form of IMRT. ISBT should be employed in treatment armamentarium to dose escalate and thereby improve survival especially in oropharyngeal malignancies.

Update Treatment HPV-16-positive Oropharyngeal Carcinoma

Oropharynx carcinoma (OPSCC) is a genetically heterogeneous tumor group with high prognostic diversity due to its worldwide increase in incidence and the association with the human papillomavirus HPV 16, but also chronic tobacco/alcohol consumption. The review attempts to present the current view on therapy and prevention of OPSCC with respect to association with HPV 16. The overview is based on the current relevant literature as well as current studies. The OPSCC presents itself as a very complex, genetically heterogeneous group of head and neck tumors, which should therefore be considered in detail. The currently contradictory trial situation of retrospective studies versus prospective trials, the current TNM classification (8th edition) and the scarce prospective data arguing for non-inferiority of therapy de-intensification attempts currently admonish to encourage a more conservative treatment.

Germline variants in DNA repair genes are associated with young-onset head and neck cancer

The genetic predisposition to head and neck carcinomas (HNSCC) and how the known risk factors (papillomavirus infection, alcohol, and tobacco consumption) contribute to the early-onset disease are barely explored. Although HNSCC at early onset is rare, its frequency is increasing in recent years. Germline and somatic variants were assessed to build a comprehensive genetic influence pattern in HNSCC predisposition and patient outcome. Whole-exome sequencing was performed in 45 oral and oropharynx carcinomas paired with normal samples of young adults (≤49 years). We found FANCG, CDKN2A, and TPP germline variants previously associated with HNSCC risk. At least one germline variant in DNA repair pathway genes was detected in 67% of cases. Germline and somatic variants (including copy number variations) in FAT1 gene were identified in 9 patients (20%) and 12 tumors (30%), respectively. Somatic variants were found in HNSCC associated genes, such as TP53, CDKN2A, and PIK3CA. To date, 55 of 521 cases from the large cohort of TCGA presented < 49 years old. A comparison between the somatic alterations of TCGA-HNSCC at early onset and our dataset revealed strong similarities. Protein-protein interaction analysis between somatic and germline altered genes revealed a central role of TP53. Altogether, germline alterations in DNA repair genes potentially contribute to an increased risk of developing HNSCC at early-onset, while FAT1 could impact the prognosis.

PO-0994 Correlation of PDL1-Tumor Infiltrating Lymphocytes in Carcinoma Oropharynx with toxicity & response

PO-0994 Correlation of PDL1-Tumor Infiltrating Lymphocytes in Carcinoma Oropharynx with toxicity & response

P-55 Contemporary swallowing outcome for oropharynx carcinoma following definitive VMAT (chemo)radiotherapy

P-55 Contemporary swallowing outcome for oropharynx carcinoma following definitive VMAT (chemo)radiotherapy