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. 2014 May;50(5):513-9.
doi: 10.1016/j.oraloncology.2014.02.001. Epub 2014 Feb 22.

Refining risk stratification for locoregional failure after chemoradiotherapy in human papillomavirus-associated oropharyngeal cancer

Jeffrey M Vainshtein  1 , Matthew E Spector  2 , Jonathan B McHugh  3 , Ka Kit Wong  4 , Heather M Walline  5 , Serena A Byrd  6 , Christine M Komarck  7 , Mohannad Ibrahim  8 , Matthew H Stenmark  1 , Mark E Prince  2 , Carol R Bradford  2 , Gregory T Wolf  2 , Scott McLean  2 , Francis P Worden  9 , Douglas B Chepeha  2 , Thomas Carey  2 , Avraham Eisbruch  10
Affiliations

Refining risk stratification for locoregional failure after chemoradiotherapy in human papillomavirus-associated oropharyngeal cancer

Jeffrey M Vainshtein et al. Oral Oncol. 2014 May.

Abstract

Background: To determine whether the addition of molecular and imaging biomarkers to established clinical risk factors could help predict locoregional failure (LRF) after chemoradiation in human papillomavirus (HPV)-related (+) oropharyngeal cancer (OPC) and improve patient selection for locoregional treatment de-intensification.

Methods: HPV status was determined for 198 consecutive patients with stage III/IV OPC treated with definitive chemoradiation from 5/2003 to 10/2010. The impact of pre-therapy epidermal growth factor receptor (EGFR) overexpression; imaging biomarkers including primary tumor and nodal maximum standardized uptake values on FDG-PET, gross tumor volumes, and matted nodes; and clinical factors on LRF (including residual disease at adjuvant neck dissection) was assessed.

Results: Primary tumors were HPV+ in 184 patients and HPV-negative in 14. EGFR overexpression was related to HPV-negative status and was univariately associated with LRF in the overall population, but was neither retained in the multivariate model after adjustment for HPV status, nor associated with LRF in HPV+ patients. Similarly, imaging biomarkers were univariately associated with LRF, but correlated with T-stage and/or N-stage and did not remain predictive in HPV+ patients after adjustment for T4- and N3-stages, which were the only significant predictors of LRF on multivariate analysis. Among HPV+ patients with non-T4- or N3-stages, only minimal smoking was associated with decreased LRF.

Conclusions: The prognostic impact of EGFR overexpression and imaging biomarkers on LRF was predominantly related to their association with HPV-negative status and T- or N-stage, respectively. Among HPV+ OPC patients treated with uniform chemoradiation, only T4-stage, N3-stage, and smoking contributed to risk-stratification for LRF.

Keywords: EGFR; FDG-PET; HPV; Local-regional failure; Oropharyngeal cancer; Risk stratification.

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Conflict of interest statement

The authors have no financial conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Locoregional Control by HPV Status.
Figure 2
Figure 2
Locoregional Control by EGFR Overexpression in the (A) Overall and (B) HPV+ Cohorts
Figure 3
Figure 3
Risk-Stratification for Locoregional Control in HPV-Related Oropharyngeal Cancer. Locoregional control stratified by (A) T- and N-stage in all HPV+ patients, (B) Smoking history (≥vs.< 10 pack-years) in T1-3 N0-2c patients, and (C) T-stage, N-stage, and Smoking history among all HPV+ patients.
See this image and copyright information in PMC

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