title: Impact of retropharyngeal adenopathy on distant control and survival in HPV-related oropharyngeal cancer treated with chemoradiotherapy.
abstract: OBJECTIVE
  Retropharyngeal adenopathy (RPA) is poor prognostic factor in head and neck (HN) cancer. However, the prognostic significance of RPA in Human Papillomavirus-related (HPV+) oropharyngeal cancer (OPC) is unknown.
  
  
  METHODS
  185 patients with HPV+OPC were assessed. Pre-therapy images reviewed by a HN radiologist to determine presence of RPA. Doses to the RPAs were determined from treatment plans. Outcomes analyzed using Kaplan-Meier method, log-rank tests, and correlations determined using Spearman's rank analyses.
  
  
  RESULTS
  29 (16%) of the HPV+patients had RPA. At median follow-up 49months, 5-year overall survival (OS), failure-free survival (FFS) and distant failure-free survival (DFFS) were 57% vs. 81% (P=0.02), 63% vs 80% (P=0.015) and 70% vs 91% (P=0.002) for patients with/without RPA, respectively. No differences observed in local/ regional control rates, exceeding 90% in both groups, and No RPA recurrences were observed. In multivariable analysis, stages T4 or N3, and RPA, were independently, statistically significantly associated with both OS and distant failure, while N2c, age, disease site, and smoking status, were not.
  
  
  CONCLUSIONS
  RPA in HPV+OPC is an independent prognostic factor for distant failure, translating into worse OS. Patients with RPA may not be suitable candidates for trials of systemic treatment de-escalation.
authors.affiliation: Department of Radiation Oncology, University of Michigan, United States.
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Samuels
authors.affiliation: Department of Radiation Oncology, University of Michigan, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vainshtein
authors.affiliation: Department of Otorhinolaryngology-Head Neck Surgery, University of Michigan, United States.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.affiliation: Department of Radiology, University of Michigan, United States.
authors.forename: Mohannad
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Pathology, University of Michigan, United States.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: McHugh
authors.affiliation: Department of Biostatistics, University of Michigan, United States.
authors.forename: Yebin
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Radiation Oncology, University of Michigan, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schipper
authors.affiliation: Department of Medicine - Medical Oncology Division, University of Michigan, United States.
authors.forename: Francis
authors.initials: F
authors.lastname: Worden
authors.affiliation: Department of Radiation Oncology, University of Michigan, United States. Electronic address: Eisbruch@umich.edu.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000628:therapy* / Q000821:virology; D027383:Papillomaviridae; D011379:Prognosis
keywords: Chemo-radiotherapy; Human papillomavirus (HPV); Oropharyngeal cancer; Retropharyngeal nodes