Chemoradiation For Oropharyngeal Cancer Research Articles

Optimal Threshold of Smoking in Pack-Years and its Association with Survival Outcomes Among Patients Treated with Chemoradiation for Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> A secondary analysis of RTOG 0129 established 10 pack-years of smoking as a threshold of risk stratification for survival among patients treated with chemoradiation for oropharyngeal cancer. We performed a single-institution, observational cohort study to evaluate the optimal threshold of pack-years of smoking and validate 10 pack-years as a prognostic factor. <h3>Materials/Methods</h3> A single-institution, retrospective database was queried for patients with non-metastatic head and neck cancer who underwent definitive-intent chemoradiation from January 2005 to April 2021. An optimal threshold of pack-years of smoking was evaluated based on maximizing log-rank test statistic, and heavy smokers were defined as those with above the threshold. Cox multivariable analysis (MVA) and Kaplan-Meier method were performed to analyze overall survival (OS) and progression-free survival (PFS). Multivariable Fine-Gray competing risk analysis was performed for locoregional (LRF) and distant failure (DF) outcomes with death as a competing event. Propensity score matching was performed to construct matched pairs based on nearest neighbor method in a 1:1 ratio with no replacement. Multivariable analyses were repeated using 10 pack-years of smoking as a threshold. <h3>Results</h3> A total of 518 patients were identified for analysis. Median follow up was 44.1 months (interquartile range 22.3-72.8). The threshold of smoking in pack-years was determined to be 22. On Cox MVA, heavy smokers were associated with worse OS (adjusted hazards ratio [aHR] 1.64, 95% confidence interval [CI] 1.17-2.30, p=0.004) and PFS (aHR 1.42, 95% CI 1.04-1.93, p=0.03). On multivariable Fine-Gray competing risk model, heavy smokers were associated with worse DF (aHR 1.70, 95% CI 1.03-2.83, p=0.04), but not LRF (aHR 1.03, 95% CI 0.59-1.78, p=0.92). Similar findings were noted among 141 matched pairs (OS: HR 1.93, 95% CI 1.29-2.88, p=0.001; PFS: HR 1.50, 95% CI 1.04-2.16, p=0.03; LRF: HR 0.92, 95% CI 0.49-1.71, p=0.78; DF: HR 1.94, 95% CI 1.02-3.68, p=0.04). However, heavy smokers defined using 10 pack-years of smoking as a threshold were not associated with OS (aHR 1.41, 95% CI 0.97-2.06, p=0.07), PFS (aHR 1.21, 95% CI 0.87-1.70, p=0.26), LRF (aHR 1.19, 95% CI 0.66-2.16, p=0.56), or DF (aHR 1.51, 95% CI 0.88-2.58, p=0.13). <h3>Conclusion</h3> In our study, heavy smoking based on 22 pack-years of smoking as a threshold was an independent adverse prognostic factor for survival and distant metastasis. However, using 10 pack-year of smoking as a threshold was not associated with such outcomes. Further studies are warranted to optimize the role of smoking in pack-years for risk stratification.

Baroreceptor Reflex Failure after Curative Chemoradiation for Oropharyngeal Cancer: A Potential Use of an Established Therapy

Baroreceptor Reflex Failure after Curative Chemoradiation for Oropharyngeal Cancer: A Potential Use of an Established Therapy

Impact of Intensity-Modulated Proton Therapy vs. Intensity-Modulated Photon Therapy on Preserving Work and Productivity in Oropharyngeal Cancer Patients: Outcomes of a Multi-Institution Randomized Trial

Oropharyngeal cancer (OPC) patients undergoing chemoradiation (CRT) are at high risk for “financial toxicity” from missed or lost work during and after treatment, as patients undergo intensive multimodality therapy impacting acute and long-term daily activities/function. Despite growing appreciation for the need to identify optimal CRT approaches that enable preserving work, productivity, and economic burden, no randomized studies have compared how treatments impact work outcomes in OPC. We compared the effect of intensity-modulated proton therapy (IMPT) vs intensity-modulated photon therapy (IMRT) on work and productivity outcomes in OPC patients receiving CRT on a randomized trial. From 2014-2018, 188 patients were randomized to IMPT vs. IMRT for stage II-IVB (7th ed) squamous cell carcinoma of the oropharynx, stratified by induction chemotherapy, HPV/p16 and smoking. A pre-specified aim compared patient-reported work outcomes using the validated Work Productivity and Activity Impairment (WPAI) questionnaire at baseline, end of CRT, 6 months, 1 year, and 2 years. Patients reported whether they were working, and working patients scored (0-100) levels of absenteeism, impairment while working, and productivity losses over the prior 7 days. Cochran-Armitage test analyzed differences in the proportion of patients working during follow-up. WPAI scores were compared using the Wilcoxon rank sum test. Mixed effects models tested longitudinal predictors. In 96 patients receiving IMPT and 92 IMRT, median age was 59. Baseline demographics, stage, employment, and insurance were balanced. 78% (n=147) participated in patient-reported outcomes aims, with evaluable responses in 79% of patients at 6 months, 67% at 1 year and 44% at 2 years. At baseline, there was no difference in the proportion of working IMPT patients (61%) vs. IMRT patients (58%) (P=0.71). However, among IMPT patients, the proportion who returned to/maintained work after treatment significantly increased over time, from 63%-78% (P=0.02). In contrast, among IMRT patients, the proportion working was unchanged over time, from 48%-55% (P=0.58). Among working patients, absenteeism, impaired work, and productivity loss ascribed to cancer did not differ by treatment arms, approaching baseline scores by 2 years (P= 0.17 to 0.80 for IMPT vs. IMRT scores at end of CRT, 6 months, 1 year, and 2 years). Adjusted scores were comparable in multivariate models. After CRT for OPC, patients undergoing IMPT were more frequently able to return to work with comparable productivity vs. those undergoing IMRT, demonstrating an absolute benefit of 26% at 2 years. Results provide Level 1 evidence in a randomized setting, using novel outcomes measures to demonstrate favorable societal- and patient-level economic impacts of IMPT for patients with OPC.Abstract 2977; Table 1Proportion of patients working (%)RandomizationPre-CRTEnd of CRT6 Months1 Year2 YearsPPBT61%63%71%71%78%0.02IMRT58%48%55%54%52%0.58 Open table in a new tab

A case report of herpes simplex encephalitis after chemoradiation for oropharyngeal cancer

A case report of herpes simplex encephalitis after chemoradiation for oropharyngeal cancer

Predictors of prolongation in radiation treatment time in a veteran population treated with chemoradiation for oropharyngeal cancer

Background: Prolonged radiation treatment time (RTT) is associated with worse tumor control. Here we identify and determine the implications of factors that predict treatment prolongation in Veterans Affairs (VA) patients undergoing chemoradiation.Methods: Chart review from July 2000 to October 2013. 81 patients with advanced stage oropharyngeal cancer treated with chemoradiation.Results: Twenty-nine patients (35.8%) had RTT prolonged by ≥10 days. Prolongation mainly resulted from acute treatment toxicity (n = 22, 76%). There was no significant difference in RTT for patients treated with concurrent cisplatin versus cetuximab, or in patients treated with or without induction chemotherapy. One-/three-year locoregional control and overall survival rates of 83.4%/76.3% and 83.5%/63.6% for patients without prolonged RTT versus 61.8%/61.8% and 82.8%/73.8% for those with prolongation (p >.05).Conclusions: Prolonged RTT is a significant predictor of worse locoregional control and predominantly resulted from treatment side effects. More aggressive regimens with induction and concurrent chemotherapy did not predispose to prolonged RTT.

中咽頭癌におけるヒト乳頭腫ウイルス感染と化学放射線療法

米国や北欧においては中咽頭癌の罹患率が時代とともに急速に増加しているが，その原因はHPV陽性の中咽頭癌が増加しているためと考えられている。我々は頭頸部癌基礎研究会で多施設共同研究としてHPV感染の調査を行った。中咽頭癌症例は，扁平上皮癌の157例が登録され解析された。79例においてPCRでHPVが検出された。78例ではHPV陰性であった。すなわち，HPV感染率は50.0％であった。HPV陽性中咽頭癌の臨床上の特徴は進行癌が多い傾向が見られ側壁すなわち扁桃癌が有意に多く喫煙歴，飲酒歴がない症例が多い結果であった。予後については化学放射線療法を中心に行った症例の71例では，HPV陽性例で2年全体生存率が92％，HPV陰性例で63％と有意にHPV陽性例で予後良好であった。中咽頭癌におけるHPV感染の有無は治療効果と予後に大きく関連することが明らかとなっているが，HPV感染の有無による治療強度の検討に関しては今後の臨床試験の結果を待たなくてはならない。

Predictors of Worsening Dysphagia following Chemoradiation for Oropharyngeal Cancer: Results from a Two-year Prospective Longitudinal Study

Predictors of Worsening Dysphagia following Chemoradiation for Oropharyngeal Cancer: Results from a Two-year Prospective Longitudinal Study

Dose-response Relationships for Lhermitte's Sign following Chemoradiation for Oropharyngeal Cancer

Dose-response Relationships for Lhermitte's Sign following Chemoradiation for Oropharyngeal Cancer

Dose-response Relationships for Worsening Patient-reported Voice Quality following Chemoradiation for Oropharyngeal Cancer

Dose-response Relationships for Worsening Patient-reported Voice Quality following Chemoradiation for Oropharyngeal Cancer