title: Induction chemotherapy followed by concurrent chemoradiotherapy for advanced stage oropharyngeal squamous cell carcinoma with HPV and P16 testing.
abstract: OBJECTIVE
  The objective was to report our experience with advanced stage oropharyngeal squamous cell carcinoma treated sequentially with induction chemotherapy followed by concurrent chemoradiotherapy.
  
  
  METHODS
  Retrospective chart review identified 49 eligible patients with advanced stage oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiotherapy. HPV and p16(INK4A) testing was performed on pathology specimens. Follow-up of over 11 months was required unless a death or treatment failure occurred before that time.
  
  
  RESULTS
  Treatment with induction chemotherapy followed by concurrent chemoradiotherapy resulted in 44/48 (90%) complete durable response. One death occurred from pulmonary embolism. Toxicity profiles were comparable to other published data. Average follow-up was 3.9 years. Oncologic failure rates among subgroups showed 5.7% failure for HPV+/p16+ cancer, 9.1% failure for HPV-/p16+ cancer, 100% failure for HPV-/p16- cancer, 0% failure for nonsmokers, and 17.9% failure for smokers.
  
  
  CONCLUSIONS
  This study showed favorable outcomes in terms of durable oncologic response and acceptable toxicity profiles. It is notable that 36/49 patients were HPV+/p16+ and 11/49 were HPV-/p16+. Only 2 patients were HPV-/p16-, and both died as a result of oncologic failures. This highlights the importance of obtaining HPV and p16 testing in studies evaluating the efficacy of treatments for oropharyngeal squamous cell carcinoma.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Flavill
authors.forename: Yisheng V
authors.initials: YV
authors.lastname: Fang
authors.forename: Brett
authors.initials: B
authors.lastname: Miles
authors.forename: John
authors.initials: J
authors.lastname: Truelson
authors.forename: Steve
authors.initials: S
authors.lastname: Perkins
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D061809:Human Papillomavirus DNA Tests; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
keywords: human papilloma virus; induction chemotherapy; oropharyngeal squamous cell carcinoma; p16; sequential chemotherapy