title: Determining optimal follow-up in the management of human papillomavirus-positive oropharyngeal cancer.
abstract: BACKGROUND
  Determining the optimal follow-up for patients can help maximize the use of health care resources. This is particularly true in a growing epidemic such as human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV+OPSCC). The objective of the current study was to evaluate time to disease recurrence or late toxicity in this cohort of patients to optimize patient management.
  
  
  METHODS
  An institutional database identified 232 patients with biopsy-proven, nonmetastatic HPV+OPSCC who were treated with radiotherapy. A retrospective review was conducted in patients who were followed every 3 months for the first year, every 4 months in year 2, and every 6 months in years 3 to 5. Late toxicity (grade ≥ 3; toxicity was scored based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4]), locoregional control, distant control, and overall survival were assessed.
  
  
  RESULTS
  The median follow-up was 33 months. Based on Radiation Therapy Oncology Group (RTOG) 0129 study risk groupings, patients were either considered to be at low (162 patients; 70%) or intermediate (70 patients; 30%) risk. Concurrent systemic therapy was used in 85% of patients (196 patients). The 3-year locoregional control, distant control, and overall survival rates were 94%, 91%, and 91%, respectively. Late toxicity occurred in 9% of patients (21 patients). Overall, 64% of toxicity and failure events occurred within the first 6 months of follow-up, with a < 2% event incidence noted at each subsequent follow-up. Only 4 patients experienced their first event after 2 years.
  
  
  CONCLUSIONS
  HPV+OPSCC has a low risk of disease recurrence and late toxicity after treatment; approximately two-thirds of events occur within the first 6 months of follow-up. These data suggest that it may be reasonable to reduce follow-up in patients with HPV+OPSCC to every 3 months for the first 6 months, every 6 months for the first 2 years, and annually thereafter.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Frakes
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Arash O
authors.initials: AO
authors.lastname: Naghavi
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Demetriou
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Tobin J
authors.initials: TJ
authors.lastname: Strom
authors.affiliation: Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Russell
authors.affiliation: Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Kish
authors.affiliation: Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Judith C
authors.initials: JC
authors.lastname: McCaffrey
authors.affiliation: Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Otto
authors.affiliation: Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padhya
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Andy M
authors.initials: AM
authors.lastname: Trotti
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Caudell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology; D000068818:Cetuximab / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy* / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications*; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis*; D011878:Radiotherapy; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D000068818:Cetuximab; D002945:Cisplatin
keywords: follow-up; human papillomavirus (HPV); oropharynx cancer; outcome; radiotherapy; toxicity