title: HPV: a factor in organ preservation for locally advanced larynx and hypopharynx cancer?
abstract: OBJECTIVE
  To assess the interaction of HPV/p16 status and therapy rendered in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx.
  
  
  METHODS
  Forty-seven consecutive patients receiving definitive treatment between 2009 and 2011 for locally advanced larynx or hypopharynx cancer with high-risk HPV and/or p16 testing performed were identified and retrospectively investigated. Overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) were assessed.
  
  
  RESULTS
  Of 47 evaluable patients, there were 38 (81%) with laryngeal and 9 (19%) with hypopharyngeal tumors, 13 (28%) of which were found to be either HPV or p16 positive. At a median follow-up of 24 months, comparing HPV/p16+ versus HPV/p16- patients, there was no difference in OS, DFS, or LRFS. There was an improvement in 2-year DFS (60% vs 100%, P=.03) and LRFS (80% vs 100%, P=.08), in HPV/p16+ patients treated with chemo/RT versus surgery. There was an improvement in 2-year DFS (100% vs 68%, P=.04) and LRFS (100% vs 72%, P=.05) in HPV/p16+ versus HPV/p16- patients who received chemo/RT.
  
  
  CONCLUSIONS
  Patients with HPV/p16+ tumors fared more favorably with chemo/RT than up-front surgery, with improvements in DFS and LRFS. In patients treated with the intent of organ preservation therapy, HPV/p16+ patients had no observed treatment failures. HPV/p16 status should be taken into account when considering organ preservation for locally advanced larynx and hypopharynx cancers.
authors.affiliation: University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, KY USA. Electronic address: jnshau01@louisville.edu.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Shaughnessy
authors.forename: Hanan
authors.initials: H
authors.lastname: Farghaly
authors.forename: Liz
authors.initials: L
authors.lastname: Wilson
authors.forename: Rebecca
authors.initials: R
authors.lastname: Redman
authors.forename: Kevin
authors.initials: K
authors.lastname: Potts
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bumpous
authors.forename: Craig
authors.initials: C
authors.lastname: Silverman
authors.forename: Neal E
authors.initials: NE
authors.lastname: Dunlap
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000821:virology; D052162:Human papillomavirus 16 / Q000302:isolation & purification / Q000378:metabolism; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011379:Prognosis; D000077195:Squamous Cell Carcinoma of Head and Neck