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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2017

01-11-2017 | Head and Neck Oncology

Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy

Authors: Ryan S. Jackson, MD, Parul Sinha, MBBS, MS, Joseph Zenga, MD, Dorina Kallogjeri, MD, MPH, Jasmina Suko, MSc, Eliot Martin, PA-C, Eric J. Moore, MD, Bruce H. Haughey, MBChB, MS

Published in: Annals of Surgical Oncology | Issue 12/2017

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Abstract

Background

With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma.

Methods

A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4).

Results

The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1–102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01–0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02–0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02–2.57) or overall survival (HR 0.18; 95% CI 0.01–2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6–20.6).

Conclusions

Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
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Metadata
Title
Transoral Resection of Human Papillomavirus (HPV)-Positive Squamous Cell Carcinoma of the Oropharynx: Outcomes with and Without Adjuvant Therapy
Authors
Ryan S. Jackson, MD
Parul Sinha, MBBS, MS
Joseph Zenga, MD
Dorina Kallogjeri, MD, MPH
Jasmina Suko, MSc
Eliot Martin, PA-C
Eric J. Moore, MD
Bruce H. Haughey, MBChB, MS
Publication date
01-11-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6041-x

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