title: Treatment-related outcome of oropharyngeal cancer patients differentiated by HPV dictated risk profile: a tertiary cancer centre series analysis.
abstract: BACKGROUND
  To date, no treatment modality has been identified as more effective for oropharyngeal cancer (OPC), and no predictive factors are known to guide treatment decision for this disease. This retrospective study evaluates the differential effects of diverse treatment options for OPC according to patient risk profiles.
  
  
  METHODS
  We considered two series of locally advanced squamous cell OPC patients treated with either surgery followed by radiotherapy (surgical series) or chemoradiation (CRT) with/without induction docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy (CRT series). Smoking habits, tumor p16 expression/human papillomavirus (HPV) status and T and N stage were analyzed to stratify the patients according to Ang's risk profile (low, intermediate and high risk). Overall survival (OS) and disease-free survival were calculated with the Kaplan-Meier method.
  
  
  RESULTS
  Globally, 171 patients were considered, 56 in surgical and 115 in CRT series. Patients were stratified in low- (20% of surgical and CRT groups), intermediate- (23% and 41%) and high-risk (57% and 39%) groups. In the surgical series, 5-year OS was 54.5%, 46.9% and 40.0% in low, intermediate and high Ang's risk profiles, respectively, whereas in the CRT series those were 100%, 78.9% and 46.7%, respectively. In the multivariable analyses, adjusting for inhomogeneity between the treatment group, the CRT effect was significantly higher in the low- and intermediate-risk groups (P-value for the interaction treatment risk group = 0.034 in the OS analysis).
  
  
  CONCLUSIONS
  In this retrospective analysis, low- and intermediate-risk OPC patients had a better survival when treated with CRT compared with open surgery followed by radiation therapy. These data suggest that different treatment approaches might be essential in determining outcome results.
authors: Head and Neck Cancer Medical Oncology Unit. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors: P
authors: P
authors: Bossi
authors: Radiotherapy Unit.
authors: E
authors: E
authors: Orlandi
authors: Clinical Epidemiology and Trial Organization Unit.
authors: R
authors: R
authors: Miceli
authors: Laboratory of Experimental Molecular Pathology, Department of Pathology.
authors: F
authors: F
authors: Perrone
authors: Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: M
authors: M
authors: Guzzo
authors: Clinical Epidemiology and Trial Organization Unit.
authors: L
authors: L
authors: Mariani
authors: Head and Neck Cancer Medical Oncology Unit.
authors: R
authors: R
authors: Granata
authors: Head and Neck Cancer Medical Oncology Unit.
authors: L
authors: L
authors: Locati
authors: Radiotherapy Unit.
authors: C
authors: C
authors: Fallai
authors: Laboratory of Experimental Molecular Pathology, Department of Pathology.
authors: B
authors: B
authors: Cortelazzi
authors: Laboratory of Experimental Molecular Pathology, Department of Pathology.
authors: S
authors: S
authors: Pilotti
authors: Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: G
authors: G
authors: Scaramellini
authors: Laboratory of Experimental Molecular Pathology, Department of Pathology.
authors: A
authors: A
authors: Gloghini
authors: Head and Neck Cancer Medical Oncology Unit.
authors: L
authors: L
authors: Licitra
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000096:biosynthesis; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000473:pathology*; D012189:Retrospective Studies; D043823:Taxoids / Q000627:therapeutic use; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D019941:Cyclin-Dependent Kinase Inhibitor p16; D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil
keywords: chemoradiation; human papilloma virus; oropharyngeal cancer; risk profile; survival