title: Outcomes of HPV-related oropharyngeal cancer patients treated by radiotherapy alone using altered fractionation.
abstract: OBJECTIVE
  To report outcome of HPV-related [HPV(+)] oropharyngeal cancer (OPC) managed predominantly by altered-fractionation radiotherapy-alone (RT-alone).
  
  
  METHODS
  OPCs treated with RT-alone (n = 207) or chemoradiotherapy (CRT) (n = 151) from 2001 to 2008 were included. Overall survival (OS), local (LC), regional (RC) and distant (DC) control were compared for HPV(+) vs. HPV-unrelated [HPV(-)], by RT-alone vs. CRT, and by smoking pack-years (≤ 10 vs. >10). Multivariate analysis identified predictors.
  
  
  RESULTS
  HPV(+) (n = 277) had better OS (81% vs. 44%), LC (93% vs. 76%), RC (94% vs. 79%) (all p < 0.01) but similar DC (89% vs. 86%, p = 0.87) vs. HPV(-) (n = 81). HPV(+) stage IV CRT (n = 125) had better OS (89% vs. 70%, p < 0.01), but similar LC (93% vs. 90%, p = 0.41), RC (94% vs. 90%, p = 0.31) and DC (90% vs. 83%, p = 0.22) vs. RT-alone (n = 96). Both HPV(+) RT-alone (n = 37) and CRT (n = 67) stage IV minimal smokers had favorable OS (86% vs. 88%, p = 0.45), LC (95% vs. 92%, p = 0.52), RC (97% vs. 93%, p = 0.22), and DC (92% vs. 86%, p = 0.37). RT-alone and heavy-smoking were independent predictors for lower OS but not CSS in multivariate analysis.
  
  
  CONCLUSIONS
  Overall, HPV(+) RT-alone stage IV demonstrated lower survival but comparable disease control vs. CRT, but no difference was apparent among minimal smokers.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada. Brian.OSullivan@rmp.uhn.on.ca
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: Bayardo
authors.initials: B
authors.lastname: Perez-Ordonez
authors.forename: Christine
authors.initials: C
authors.lastname: Massey
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Siu
authors.forename: Ilan
authors.initials: I
authors.lastname: Weinreb
authors.forename: Andrew
authors.initials: A
authors.lastname: Hope
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bayley
authors.forename: Bernard
authors.initials: B
authors.lastname: Cummings
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.forename: Laura A
authors.initials: LA
authors.lastname: Dawson
authors.forename: B C John
authors.initials: BC
authors.lastname: Cho
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.forename: Angela
authors.initials: A
authors.lastname: Hui
authors.forename: Fei-Fei
authors.initials: FF
authors.lastname: Liu
authors.forename: Helen
authors.initials: H
authors.lastname: Zhao
authors.forename: John N
authors.initials: JN
authors.lastname: Waldron
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D030361:Papillomavirus Infections / Q000150:complications*