title: Adjuvant Radiation Therapy Alone for HPV Related Oropharyngeal Cancers with High Risk Features.
abstract: BACKGROUND
  Current standard of care for oropharyngeal cancers with positive surgical margins and/or extracapsular extension is adjuvant chemoradiotherapy. It is unknown whether HPV+ oropharyngeal cancer benefits from this treatment intensification.
  
  
  OBJECTIVE
  To investigate the outcomes of HPV+ patients treated with adjuvant radiotherapy alone when chemoradiotherapy was indicated based on high risk pathological features. They were compared with high risk HPV+ patients treated with adjuvant chemoradiotherapy.
  
  
  METHODS
  All high risk HPV+ oropharyngeal cancer patients (9) who received radiotherapy alone were identified. We also identified 17 patients who received chemoradiotherapy as a comparison group. Median follow up time was 37.3 months.
  
  
  RESULTS
  No local failures developed in adjuvant radiotherapy group. There was 1 distant recurrence in this cohort and 3 in CRT cohort. Regarding toxicity, 8 (47.1%) chemoradiotherapy patients had >10 lb. weight loss (p = 0.013), despite 75% of them having a percutaneous endoscopic gastrostomy tube placed. No individuals in radiotherapy group experienced a >10 lb. weight loss and none required a gastrostomy tube.
  
  
  CONCLUSIONS
  This series provides preliminary evidence suggesting that the omission of concurrent chemotherapy to adjuvant radiotherapy may offer comparative local control rates with a lower toxicity profile in the setting of HPV+ patients with traditional high risk features.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Su
authors.affiliation: Department of Radiation Oncology, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: Jerry
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.affiliation: Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Misiukiewicz
authors.affiliation: Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Marshall
authors.initials: M
authors.lastname: Posner
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Bakst
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000209:etiology / Q000532:radiotherapy* / Q000628:therapy / Q000821:virology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome