Prognostic significance of HPV status in the re-irradiation of recurrent and second primary cancers of the head and neck
Introduction
The incidence of head and neck squamous cell carcinoma (HNSCC) attributed to human papillomavirus (HPV) has risen over the last decade [1]. Although numerous studies have convincingly demonstrated that patients with HPV-positive HNSCC have a more favorable prognosis with at least half the risk of death compared to their counterparts with HPV-negative HNSCC, a significant proportion of the former group nevertheless experience disease progression [[2], [3], [4]]. For patients who develop isolated local-regional failures after initial therapy for HPV-positive HNSCC, treatment options have generally included salvage surgery, re-irradiation, chemotherapy, and/or a combination of each of the above [5]. While data from a recently published subset analysis of two prospective trials conducted by the Radiation Therapy Oncology Group (RTOG) showed that HPV status remains a strong prognostic factor in the recurrent setting (with a 2-year overall survival rate of 55% in HPV-positive patients compared to 28% in the HPV-negative population), the conclusions did not differentiate between those with local-regional failures, distant metastasis, or both [6]. The purpose of this study was to thus assess the impact of HPV status on survival for patients with local-regionally recurrent HNSCC who underwent re-irradiation with external beam therapy, either as the primary modality or post-operatively after surgery, with the goal of determining whether HPV maintains its prognostic significance in this setting.
Section snippets
Study design
This study was approved by the institutional review board at our institution prior to the collection of all patient information. The medical records of 54 consecutive patients who underwent re-irradiation at a large tertiary-care comprehensive cancer center between April 2011 and January 2016 for local-regionally recurrent squamous cell carcinoma of the head and neck occurring in a previously irradiated field were reviewed. Only patients with biopsy-proven evidence of gross recurrent disease
Results
There were no significant differences in age (p = 0.08), gender (p = 0.2), smoking history, time interval between radiation courses (p = 0.80), performance status (p = 0.10), and use of concurrent chemotherapy (p = 0.30) between the HPV-positive and HPV-negative/unknown cohorts. Patients in the HPV-positive group (68.8%) were more likely to have received surgery prior to re-irradiation than those in the HPV-negative/unknown group (68.8% vs. 31.6%), (p = 0.01).
The median overall survival in the
Discussion
Although local-regional recurrences are relatively rare after definitive treatment for HPV-positive HNSCC, the recognition that they do occur coupled with the increasing incidence of this disease make it imperative to seek out therapeutic modalities for patients who present with recurrent disease [[7], [8], [9], [10]]. Our findings, suggesting that HPV-positive patients with local-regionally recurrent HNSCC are more likely to be salvaged with re-irradiation than those who are HPV-negative, are
Declarations of interest
None
Funding
None
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Cited by (9)
Palliative radiotherapy in the head and neck
2023, Palliative Radiation OncologyRetreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society Appropriate Use Criteria
2022, International Journal of Radiation Oncology Biology PhysicsPalliative Radiation Therapy for Head and Neck Cancers
2019, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Such patients respond well to immunotherapy, as demonstrated by the CHECKMATE-141 trial, and treatment options include immunotherapy followed by palliative radiation at progression, palliative radiation followed by immunotherapy at progression, or the use of a concurrent therapy approach.38 Reirradiation for HPV-positive cancers is associated with improved overall and progression-free survival.49 Given the improved prognosis of such patients, a reirradiation course of 70 Gy in 35 fractions can be considered if organs at risk are within reirradiation dose constraints.
Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: A review of the literature
2019, Critical Reviews in Oncology/HematologyCitation Excerpt :The factors involved were stage of recurrent disease, site of recurrence (oral cavity carrying a worse prognosis), presence of organ dysfunction, salvage surgery and RT dose. HPV status confirmed its positive prognostic role also in patients re-irradiated for recurrence (Davis et al., 2014; Velez et al., 2018). Several authors reported that previous treatment with concurrent chemo-RT was predictive for worse OS after re-irradiation (Choe et al., 2011; Nagar et al., 2004), possibly due to more pronounced proliferation of fibrous tissue in the treated area after intensive chemoradiation and/or the presence of a highly RT-resistant tumor clones in recurrent tumor that survived initial chemo-RT.
In Regard to Ward et al
2018, International Journal of Radiation Oncology Biology Physics