Adjuvant chemoradiation therapy with high-dose versus weekly cisplatin for resected, locally-advanced HPV/p16-positive and negative head and neck squamous cell carcinoma.
OBJECTIVE
Standard treatment for patients with poor-risk, resected head and neck squamous cell carcinoma (HNSCC) is adjuvant radiation therapy combined with high-dose cisplatin. Many patients are treated with weekly cisplatin; it is not known whether weekly and high-dose cisplatin are equivalent. This study compares the outcomes of patients with locally-advanced HPV-negative HNSCC and HPV/p16-positive oropharynx HNSCC treated with adjuvant chemoradiation therapy with either high-dose or weekly cisplatin.


METHODS
Retrospective review of patients with Stage III/IV HNSCC who had surgery followed by adjuvant chemoradiation therapy at Mayo Clinic, Rochester. HPV and/or p16 status was available for all oropharynx patients.


RESULTS
104 Patients (51 high-dose, 53 weekly) were analyzed. The 3-year overall survival was 84% and 75% for patients who received high dose and weekly cisplatin, respectively (p=0.30). The 3-year recurrence free survival was 71% and 74% in the high dose and weekly cisplatin group, respectively (p=0.95). Patients with HPV/p16-positive oropharynx cancer who received adjuvant chemoradiation therapy with high-dose and weekly cisplatin had three-year overall survival rates of 91% and 86% (p=0.56), and 3-year recurrence free survival of 84% and 82% (p=0.93). Extracapsular extension did not affect prognosis in either group.


CONCLUSIONS
No significant survival difference was seen between patients with locally advanced HNSCC treated with adjuvant chemoradiation therapy with high-dose or weekly cisplatin, although there was a trend for improved survival with high-dose cisplatin. Weekly cisplatin in the adjuvant setting may be a better treatment for patients with HPV-positive oropharynx cancer to preserve survival and minimize toxicity.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
Jessica L
JL
Geiger
Department of Pathology, Al Jumhori Teaching Hospital, Mosul, Iraq.
Ahmed F
AF
Lazim
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
Francis J
FJ
Walsh
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States.
Robert L
RL
Foote
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
Eric J
EJ
Moore
Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
Scott H
SH
Okuno
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
Kerry D
KD
Olsen
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
Jan L
JL
Kasperbauer
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
Daniel L
DL
Price
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States.
Yolanda I
YI
Garces
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States.
Daniel J
DJ
Ma
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States.
Michelle A
MA
Neben-Wittich
Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
Julian R
JR
Molina
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
Joaquin J
JJ
Garcia
Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States. Electronic address: price.katharine@mayo.edu.
Katharine A R
KA
Price
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery / Q000821:virology; D006801:Humans; D008297:Male; D027383:Papillomaviridae / Q000302:isolation & purification*
D000970:Antineoplastic Agents; D002945:Cisplatin
Adjuvant therapy; Cisplatin; Head and neck cancer; Human papillomavirus (HPV); Oropharynx cancer; Radiotherapy