Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer

Hasegawa,Masahiro; Maeda,Hiroyuki; Deng,Zeyi; Kiyuna,Asanori; Ganaha,Akira; Yamashita,Yukashi; Matayoshi,Sen; Agena,Shinya; Toita,Takafumi; Uehara,Takayuki; Suzuki,Mikio

doi:10.3892/ijo.2014.2504

Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer

Authors:
- Masahiro Hasegawa
- Hiroyuki Maeda
- Zeyi Deng
- Asanori Kiyuna
- Akira Ganaha
- Yukashi Yamashita
- Sen Matayoshi
- Shinya Agena
- Takafumi Toita
- Takayuki Uehara
- Mikio Suzuki
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Affiliations: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan, Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Published online on: June 18, 2014 https://doi.org/10.3892/ijo.2014.2504
Pages: 1017-1026
Copyright: © Hasegawa et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

The aim of this study was to investigate human papillomavirus (HPV) infection as a predictor of concurrent chemoradiotherapy (CCRT) response and indicator of planned neck dissection (PND) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC; stage III/IV). Overall, 39 OPSCC patients (32 men, 7 women; median age 61 years, range 39-79 years) were enrolled. The primary lesion and whole neck were irradiated up to 50.4 Gy, and subsequently the primary site and metastatic lymph nodes were boosted with a further 16.2 Gy. Although several chemotherapy regimens were employed, 82.1% of OPSCC patients received the combination of nedaplatin and 5-fluorouracil. HPV-related OPSCC (16 cases) was defined as both HPV DNA-positive status by polymerase chain reaction and p16INK4a overexpression by immunohistochemistry. Patients with N2 and N3 disease received PND 2-3 months after CCRT completion. Compared to non-responders, CCRT responders showed significantly lower nodal stage (N0 to N2b) and HPV-positive status in univariate analysis. Patients with HPV-related OPSCC had longer time to treatment failure (TTF) than those with HPV-unrelated OPSCC (p=0.040). Three-year TTF was 81.3 and 47.8% in the HPV-related and HPV-unrelated groups, respectively. There were also significant differences in disease-free survival (DFS) between the two OPSCC patient groups (p=0.042). Three-year DFS was 93.8 and 66.7% in patients with HPV-related and HPV-unrelated OPSCC, respectively. Multivariate logistic analysis showed a lower risk of TTF event occurrence in HPV-related OPSCC (p=0.041) than in HPV-unrelated OPSCC. Thus, HPV testing in addition to nodal stage was useful for predicting CCRT response, especially in advanced OPSCC. Because patients who received PND showed moderate locoregional control, PND is an effective surgical procedure for controlling neck lesions in patients with advanced HPV-unrelated disease.

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