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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 6/2019

01-06-2019 | Human Papillomavirus | Original Article

Definitive radiochemotherapy or initial surgery for oropharyngeal cancer

To what extent can p16 expression be used in the decision process?

Authors: Anouchka Modesto, M.D., Thibaut Galissier, M.D., Amélie Lusque, Jean-Pierre Delord, M.D., Ph.D., Emmanuelle Uro-Coste, M.D., Ph.D., Jérôme Sarini, M.D., Frédéric Mouchet, M.D., Raphaël Lopez, M.D., Ph.D., Anne Laprie, M.D., Ph.D., Pierre Graff, M.D., Ph.D., Sébastien Vergez, M.D., Ph.D., Michel Rives, M.D.

Published in: Strahlentherapie und Onkologie | Issue 6/2019

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Abstract

Background

The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown.

Results

Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3‑year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002.

Conclusion

Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.
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Metadata
Title
Definitive radiochemotherapy or initial surgery for oropharyngeal cancer
To what extent can p16 expression be used in the decision process?
Authors
Anouchka Modesto, M.D.
Thibaut Galissier, M.D.
Amélie Lusque
Jean-Pierre Delord, M.D., Ph.D.
Emmanuelle Uro-Coste, M.D., Ph.D.
Jérôme Sarini, M.D.
Frédéric Mouchet, M.D.
Raphaël Lopez, M.D., Ph.D.
Anne Laprie, M.D., Ph.D.
Pierre Graff, M.D., Ph.D.
Sébastien Vergez, M.D., Ph.D.
Michel Rives, M.D.
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 6/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-019-01451-8

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