title: Long-term survival after distant metastasis in patients with oropharyngeal cancer.
abstract: OBJECTIVE
  For patients with oropharyngeal squamous cell carcinoma (OPSCC), especially for those with HPV-positive tumors, locoregional control is excellent. Distant metastasis, however, remains a substantial problem. The purpose of our study was to evaluate outcomes and predictors of survival after distant metastasis in OPSCC.
  
  
  METHODS
  Between June 2002 and January 2011, 25 OPSCC patients treated with curative intent subsequently developed distant metastasis. The primary end-points evaluated were time-to-distant metastasis and overall survival after development of distant metastasis. Predictors of outcome were evaluated with median regression analysis or Cox regression. Best subset models were chosen to minimize the Bayesian Information Criterion (BIC). A prognostic index for survival after distant failure was created based on the selected model.
  
  
  RESULTS
  Median time-to-distant metastasis after completion of radiation was 7.9 months (range, 1.6-25.4). Median overall survival from distant metastasis was 18.3 months (95% CI, 14.3-39.8). The overall survival rates at 1- and 2-year after development of distant metastasis were 72.0% (95% confidence interval [CI], 53.4-89.6) and 40.8% (95% CI, 20.6-61.0), respectively. In multivariate analysis, Karnofsky Performance Status score (KPS) > or = 80 (p=0.01, hazard ratio [HR] 0.15, 95% CI, 0.04-0.52) and limited, single-organ disease (p=0.003, HR 0.13, 95% CI 0.03-0.61) predicted for increased survival from distant metastasis. Patients with both limited disease and good KPS formed the most favorable risk group with a 2-year survival of 100%. Two patients with human papilloma virus (HPV)-positive tumors were alive without any evidence of disease at 64.6 and 60.4 months, respectively, after aggressive local treatment of solitary metastasis.
  
  
  CONCLUSIONS
  For OPSCC patients with limited, single-organ disease and good KPS, long-term survival can be achieved.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, United States.
authors.forename: Sean M
authors.initials: SM
authors.lastname: McBride
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Busse
authors.affiliation: Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: Clark
authors.affiliation: Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Wirth
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: awchan@partners.org.
authors.forename: Annie W
authors.initials: AW
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis; D013997:Time Factors
keywords: Distant metastasis; Human papilloma virus; Oropharyngeal carcinoma; Prognostic factors