title: Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer.
abstract: The aim of this study was to investigate human papillomavirus (HPV) infection as a predictor of concurrent chemoradiotherapy (CCRT) response and indicator of planned neck dissection (PND) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC; stage III/IV). Overall, 39 OPSCC patients (32 men, 7 women; median age 61 years, range 39-79 years) were enrolled. The primary lesion and whole neck were irradiated up to 50.4 Gy, and subsequently the primary site and metastatic lymph nodes were boosted with a further 16.2 Gy. Although several chemotherapy regimens were employed, 82.1% of OPSCC patients received the combination of nedaplatin and 5-fluorouracil. HPV-related OPSCC (16 cases) was defined as both HPV DNA-positive status by polymerase chain reaction and p16INK4a overexpression by immunohistochemistry. Patients with N2 and N3 disease received PND 2-3 months after CCRT completion. Compared to non-responders, CCRT responders showed significantly lower nodal stage (N0 to N2b) and HPV-positive status in univariate analysis. Patients with HPV-related OPSCC had longer time to treatment failure (TTF) than those with HPV-unrelated OPSCC (p=0.040). Three-year TTF was 81.3 and 47.8% in the HPV-related and HPV-unrelated groups, respectively. There were also significant differences in disease-free survival (DFS) between the two OPSCC patient groups (p=0.042). Three-year DFS was 93.8 and 66.7% in patients with HPV-related and HPV-unrelated OPSCC, respectively. Multivariate logistic analysis showed a lower risk of TTF event occurrence in HPV-related OPSCC (p=0.041) than in HPV-unrelated OPSCC. Thus, HPV testing in addition to nodal stage was useful for predicting CCRT response, especially in advanced OPSCC. Because patients who received PND showed moderate locoregional control, PND is an effective surgical procedure for controlling neck lesions in patients with advanced HPV-unrelated disease.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Masahiro
authors: M
authors: Hasegawa
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Hiroyuki
authors: H
authors: Maeda
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Zeyi
authors: Z
authors: Deng
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Asanori
authors: A
authors: Kiyuna
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Akira
authors: A
authors: Ganaha
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Yukashi
authors: Y
authors: Yamashita
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Sen
authors: S
authors: Matayoshi
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Shinya
authors: S
authors: Agena
authors: Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Takafumi
authors: T
authors: Toita
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Takayuki
authors: T
authors: Uehara
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
authors: Mikio
authors: M
authors: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy* / Q000821:virology; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy* / Q000821:virology; D030361:Papillomavirus Infections / Q000473:pathology / Q000601:surgery / Q000628:therapy* / Q000821:virology; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D009944:Organoplatinum Compounds; C053989:nedaplatin; D005472:Fluorouracil