title: Effect of multimodality treatment on overall survival for patients with metastatic or recurrent HPV-positive head and neck squamous cell carcinoma.
abstract: BACKGROUND
  The optimal treatment for patients with recurrent human papillomavirus (HPV)-positive head and neck cancer is poorly understood.
  
  
  METHODS
  We investigated treatments and outcomes in patients with recurrent head and neck cancer. Treatments included salvage neck surgery, metastasectomy, hypofractionated reirradiation, chemoembolization, and chemotherapy. Treatment outcomes were compared based on HPV status.
  
  
  RESULTS
  A total of 37 patients were identified (12 HPV positive and 25 HPV negative). Demographics were similar. Overall, there was a trend toward a higher number of total treatment interventions in patients with HPV-positive disease (4.5 vs 2.6), but this was statistically insignificant (p=.066). After a mean follow-up of 21 months, median survival in HPV-negative patients was 10.6 months, whereas the median survival had not been reached for HPV-positive patients. Of the 12 HPV-positive patients, 7 were still alive (58%) after a mean follow-up period of 33 months.
  
  
  CONCLUSIONS
  Multimodality aggressive therapy may improve overall survival in patients with recurrent HPV-positive disease. Further prospective research is warranted.
authors.affiliation: Inova Comprehensive Cancer and Research Institute, Falls Church, Virginia.
authors.forename: John F
authors.initials: JF
authors.lastname: Deeken
authors.forename: Kenneth
authors.initials: K
authors.lastname: Newkirk
authors.forename: K William
authors.initials: KW
authors.lastname: Harter
authors.forename: M Blair
authors.initials: MB
authors.lastname: Marshall
authors.forename: Filip
authors.initials: F
authors.lastname: Banovac
authors.forename: Lynt
authors.initials: L
authors.lastname: Johnson
authors.forename: Hongkun
authors.initials: H
authors.lastname: Wang
authors.forename: Yiru
authors.initials: Y
authors.lastname: Wang
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhuang
authors.forename: Ann K
authors.initials: AK
authors.lastname: Jay
authors.forename: Frank
authors.initials: F
authors.lastname: Berkowitz
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Kallakury
authors.forename: Bruce
authors.initials: B
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy* / Q000821:virology; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy / Q000821:virology*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: chemotherapy; human papillomavirus; metastasectomy; recurrent head and neck squamous cell carcinoma; reirradiation