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Tao H, Wei Y, Shen Z, Liu Z. Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension. Front Oncol 2023; 13:1089275. [PMID: 37746267 PMCID: PMC10513504 DOI: 10.3389/fonc.2023.1089275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background We conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias. Methods The matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification. Results The median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT. Conclusion The results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.
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Affiliation(s)
| | - Yumei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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2
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Li H, Zhang X, Chen W, Zhang Q, Li Q, Chen S, Yang Z, Su X, Yan S, Yang A, Song M. Analysis of T1-T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery. Laryngoscope Investig Otolaryngol 2023; 8:103-112. [PMID: 36846425 PMCID: PMC9948596 DOI: 10.1002/lio2.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China. Methods Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed. Results A total of 83 patients (HPV-positive, n = 25; HPV-negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% (P = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P < .05). Conclusion Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status. Level of Evidence 4.
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Affiliation(s)
- Hui Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xing Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wenkuan Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Quan Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiuli Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shuwei Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhongyuan Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xuan Su
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shida Yan
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ankui Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ming Song
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina,Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
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3
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Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, Bossi P, Zaniboni A. Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2022; 44:1255-1266. [PMID: 35238114 DOI: 10.1002/hed.27019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.
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Affiliation(s)
| | | | | | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Gamba
- Otolaryngology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
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Pool C, Weaver T, Zhu J, Goldenberg D, Goyal N. Surgical Margin Determination in the Era of HPV-Positive Oropharyngeal Cancer. Laryngoscope 2021; 131:E2650-E2654. [PMID: 33797105 PMCID: PMC10797598 DOI: 10.1002/lary.29533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of head and neck cancer surgery is the complete resection of tumor with a cuff of healthy tissue. A 5-mm margin is optimal but not always achievable in the oropharynx. We aimed to identify a consensus of definition and management of close margins for human papilloma virus (HPV)-associated oropharyngeal cancer without other risk factors. STUDY DESIGN Descriptive survey. METHODS A survey of the American Head and Neck Society (AHNS) was conducted to evaluate the abovementioned objectives by presenting hypothetical scenarios and asking questions regarding management. RESULTS One-hundred fifty-five AHNS members completed the survey (18% response rate). Close margins were defined as <5 mm, <3 mm, and <1 mm by 27.7%, 32.3%, and 32.3% of respondents. There was no significant difference in margin determination with experience level (P = .186). In an HPV-positive tumor with close margins, 51% chose postoperative observation. The remainder chose adjuvant radiation (22.6%), chemoradiation (1.9%), or re-excision of the wound bed (19.4%). There was no association between postoperative close margin management and experience level (P = .80). CONCLUSION Heterogeneity exists in the definition and management of close margins in HPV-mediated oropharyngeal carcinoma (OPSCC). Establishing a standard regarding close margins in HPV-mediated OPSCC may allow for the optimization of outcomes and help define best practices. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E2650-E2654, 2021.
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Affiliation(s)
- Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Taelor Weaver
- Department of Medical Education, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Miles BA, Posner MR, Gupta V, Teng MS, Bakst RL, Yao M, Misiukiewicz KJ, Chai RL, Sharma S, Westra WH, Kim‐Schulze S, Dayal B, Sobotka S, Sikora AG, Som PM, Genden EM. De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial. Oncologist 2021; 26:504-513. [PMID: 33675133 PMCID: PMC8176976 DOI: 10.1002/onco.13742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment of human papillomavirus-related oropharyngeal squamous cell carcinoma (HPVOPC) results in unprecedented high survival rates but possibly unnecessary toxicity. We hypothesized that upfront surgery and neck dissection followed by reduced-dose adjuvant therapy for early and intermediate HPVOPC would ultimately result in equivalent progression-free survival (PFS) and overall survival while reducing toxicity. METHODS This study was a nonrandomized phase II trial for early-stage HPVOPC treated with transoral robotic surgery (TORS) followed by reduced-dose radiotherapy. Patients with previously untreated p16-positive HPVOPC and <20 pack years' smoking history were enrolled. After robotic surgery, patients were assigned to group 1 (no poor risk features; surveillance), group 2 (intermediate pathologic risk factors [perineural invasion, lymphovascular invasion]; 50-Gy radiotherapy), or group 3 (poor prognostic pathologic factors [extranodal extension [ENE], more than three positive lymph nodes and positive margin]; concurrent 56-Gy chemoradiotherapy with weekly cisplatin). RESULTS Fifty-four patients were evaluable; there were 25 in group 1, 15 in group 2, and 14 in group 3. Median follow-up was 43.9 months (9.6-75.8). Disease-specific survival was 98.1%, and PFS was 90.7%. PFS probability via Kaplan-Meier was 91.3% for group 1, 86.7% for group 2, and 93.3% for group 3. There were five locoregional failures (LRFs), including one distant metastasis and one contralateral second primary. Average time to LRF was 18.9 months (9.6-59.0); four LRFs were successfully salvaged, and the patients remain disease free (11.0-42.7 months); one subject remains alive with disease. CONCLUSION The results indicate that upfront surgery with neck dissection with reduced-dose radiation for T1-2, N1 stage (by the eighth edition American Joint Committee on Cancer staging manual) HPVOPC results in favorable survival with excellent function in this population. These results support radiation dose reduction after TORS as a de-escalation strategy in HPVOPC. IMPLICATIONS FOR PRACTICE Transoral robotic surgery can provide a safe platform for de-escalation in carefully selected patients with early-stage human papillomavirus-related oropharyngeal cancer. In this clinical trial, disease-specific survival was 100%, over 90% of the cohort had a reduction of therapy from standard of care with excellent functional results, and the five patients with observed locoregional failures were successfully salvaged.
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Affiliation(s)
- Brett A. Miles
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marshall R. Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Hematology/Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marita S. Teng
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Richard L. Bakst
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Raymond L. Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Seunghee Kim‐Schulze
- Department of Immune Monitoring, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Bheesham Dayal
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Stanislaw Sobotka
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Biostatistics, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew G. Sikora
- Department of Otolaryngology, Baylor College of MedicineHoustonTexasUSA
| | - Peter M. Som
- Department of Radiology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eric M. Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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6
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Tao H, Shen Z, Liu Z, Wei Y. The Efficacy of Low Postoperative Radiation Dose in Patients with Advanced Hypopharyngeal Cancer without High-Risk Factors. Cancer Manag Res 2020; 12:7553-7560. [PMID: 32943918 PMCID: PMC7468485 DOI: 10.2147/cmar.s249725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the feasibility and efficacy of low postoperative radiotherapy (PORT) dose in patients with advanced hypopharyngeal squamous cell carcinoma (HPSCC) and identify prognostic factors in this group. Patients and Methods Between January 2013 and September 2015, 110 consecutive patients with HPSCC with no high-risk factors were treated postoperatively to 50 Gy (n=89), 56 Gy (n=12), and 60 Gy (n=9) in 2 Gy/fraction. Overall survival (OS), 3-year progression-free survival (PFS), 3-year loco-regional recurrence-free survival (LRFS), and treatment-related toxicities were analyzed. Results Median follow-up time was 40 months (range=6–75 months). The 3-year local-regional control (LRC) and 3-year neck control rate were 86.3% and 91.8%, respectively. The 3-year OS, PFS, and LRFS were 69.9%, 65.5%, and 80.5%, respectively. In a univariate analysis, T stage showed a significant correlation with improved OS, PFS, and LRFS (P=0.008, P=0.039, P=0.034). On multivariate analysis, T stage showed a significant correlation with improved OS and PFS. N stage showed a significant correlation with improved PFS. However, interval surgery-radiotherapy, reconstructive methods, and RT dose cannot serve as a significant prognostic factor for survival outcome. Conclusion This study suggests that treating no high-risk factors for locally advanced HPSCC with a dose of 50 Gy to the whole operative bed and elective lymph node levels cannot compromise disease control and survival.
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Affiliation(s)
- Hengmin Tao
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Key Laboratory of Otorhinolaryngology, National Health Commission (Shandong University), Jinan, People's Republic of China
| | - Zhong Shen
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Key Laboratory of Otorhinolaryngology, National Health Commission (Shandong University), Jinan, People's Republic of China
| | - Zhichao Liu
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Key Laboratory of Otorhinolaryngology, National Health Commission (Shandong University), Jinan, People's Republic of China
| | - Yumei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Key Laboratory of Otorhinolaryngology, National Health Commission (Shandong University), Jinan, People's Republic of China
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7
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Jackson RS, Chen S, Last A, Khan A, Kallogjeri D, Van Abel KM, Moore EJ, Pipkorn P. Multi-institutional analysis of outcomes following transoral surgery for HPV-positive oropharyngeal squamous cell carcinoma in elderly patients. Head Neck 2019; 41:3933-3939. [PMID: 31460691 DOI: 10.1002/hed.25946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/12/2019] [Accepted: 08/15/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is rising, even in elderly patients. The outcomes of transoral surgery (TOS) in this population are not entirely known. METHODS A retrospective review was performed at two institutions from October 2003 to September 2016 on patients 70 years or older with HPV-related OPSCC treated with TOS. RESULTS A total of 75 patients were included with a mean age of 74 years (70-87 years). At a median follow-up of 35.7 months, 3-year overall survival was 81.5% and disease-specific survival was 94.3%. Advanced cT stage (odds ratio, 2.74; 95% confidence interval, 1.13-6.64) negatively impacted OS. Conjunctive consolidation was performed to create a staging system with patients older than 80 years, severe comorbidity, and cT3-4 having worse survival. CONCLUSIONS Elderly patients with HPV-related OPSCC treated with TOS have excellent survival and therefore should not be excluded from such therapy based on age alone.
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Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aisling Last
- Washington University School of Medicine, St. Louis, Missouri
| | - Amish Khan
- Washington University School of Medicine, St. Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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8
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Sinha P, Karadaghy OA, Doering MM, Tuuli MG, Jackson RS, Haughey BH. Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis. Oral Oncol 2018; 86:121-31. [DOI: 10.1016/j.oraloncology.2018.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
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Sinha P, Haughey BH, Kallogjeri D, Jackson RS. Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors. Laryngoscope 2018; 129:1141-1149. [DOI: 10.1002/lary.27472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Head and Neck SurgeryFlorida Hospital Celebration Health, Celebration Florida U.S.A
- Department of SurgeryUniversity of Auckland Faculty of Medicine and Health Sciences Auckland New Zealand
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri U.S.A
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Floberg JM, DeWees TA, Chin RI, Garsa AA, Dehdashti F, Nussenbaum B, Oppelt PJ, Adkins DR, Gay HA, Thorstad WL. Pretreatment metabolic tumor volume as a prognostic factor in HPV-associated oropharyngeal cancer in the context of AJCC 8th edition staging. Head Neck 2018; 40:2280-2287. [DOI: 10.1002/hed.25337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/30/2018] [Accepted: 05/03/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- John M. Floberg
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
| | - Todd A. DeWees
- Mayo Clinic, Department of Biomedical Statistics and Informatics Scottsdale; AZ
| | - Re-I Chin
- St Louis University School of Medicine; St Louis MO
| | - Adam A. Garsa
- Keck School of Medicine of University of Southern California, Department of Radiation Oncology; Los Angeles CA
| | - Farrokh Dehdashti
- Washington University School of Medicine, Mallinckrodt Institute of Radiology Division of Nuclear Medicine; St Louis MO
| | | | - Peter J. Oppelt
- Washington University School of Medicine, Department of Internal Medicine, Division of Oncology; St Louis MO
| | - Douglas R. Adkins
- Washington University School of Medicine, Department of Internal Medicine, Division of Oncology; St Louis MO
| | - Hiram A. Gay
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
| | - Wade L. Thorstad
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
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11
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Maihoefer C, Schüttrumpf L, Macht C, Pflugradt U, Hess J, Schneider L, Woischke C, Walch A, Baumeister P, Kirchner T, Zitzelsberger H, Belka C, Ganswindt U. Postoperative (chemo) radiation in patients with squamous cell cancers of the head and neck - clinical results from the cohort of the clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer". Radiat Oncol 2018; 13:123. [PMID: 29970111 PMCID: PMC6029020 DOI: 10.1186/s13014-018-1067-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Postoperative (chemo) radiation improves tumor control and survival in high-risk patients with head and neck squamous cell carcinoma based on established risk factors. The clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer" focuses on the identification and validation of new biomarkers, which are aimed at eventually stratifying and personalizing the therapy concept. Hence, we reviewed all patients with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx, treated with postoperative (chemo) radiation from 06/2008 until 06/2015 at the Department of Radiation Oncology in the University Hospital, LMU Munich. Here we report the clinical results of the cohort, laying the foundation for further research within the framework of a clinical cooperation group. METHODS Patient data were retrospectively (until 2013) and prospectively (from 2013) collected and analyzed for outcome and treatment failures with regard to previously described and established risk factors. RESULTS We identified 302 patients (median follow-up 45 months, average age 60.7 years), having received postoperative (chemo)radiation (median 64 Gy). Chemotherapy was added in 58% of cases, mostly Cisplatin/5- Fluorouracil in concordance with the ARO 96-3 study. The 3-year overall survival, local, locoregional and distant failure estimates were 70.5, 9.7, 12.2 and 13.5%, respectively. Human papillomavirus-associated oropharyngeal cancer was associated with a significant improved overall survival, locoregional, distant and overall tumor control rates in multivariate analysis. Additionally, in multivariate analysis, for local failure, resection status and perineural invasion, for locoregional and distant failure extracapsular extension and for overall survival the presence of nodal disease were significant adverse factors. Moreover, 138 patients have been treated in concordance with the ARO 96-3 protocol, corroborating the results of this study. CONCLUSIONS Our cohort represents a large unselected cohort of patients with head and neck squamous cell carcinoma treated with postoperative (chemo)radiation. Tumor control rates and survival rates are consistent with the results of previously reported data.
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Affiliation(s)
- Cornelius Maihoefer
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lars Schüttrumpf
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Corinna Macht
- Gemeinschaftspraxis für Strahlentherapie und Radioonkolgie am Klinikum Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Ulrike Pflugradt
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Julia Hess
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Ludmila Schneider
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Christine Woischke
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Marchioninistr. 27, 81377, Munich, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Philipp Baumeister
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Kirchner
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Marchioninistr. 27, 81377, Munich, Germany
| | - Horst Zitzelsberger
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Claus Belka
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ute Ganswindt
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Radiation Oncology, University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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12
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Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, Gross N, Andersen PE, Clayburgh D. Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2017; 144:18-27. [PMID: 29075740 DOI: 10.1001/jamaoto.2017.1790] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. Objective To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). Design, Setting, and Participants This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. Main Outcomes and Measures Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. Results Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). Conclusions and Relevance Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.
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Affiliation(s)
- Virginie Achim
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Rachel K Bolognone
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Andrew D Palmer
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Donna J Graville
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Tyler J Light
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Ryan Li
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Neil Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Peter E Andersen
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Daniel Clayburgh
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
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Mohanti BK, Thakar A, Kaur J, Bahadur S, Malik M, Gandhi AK, Bhasker S, Sharma A. Postoperative radiotherapy dose requirement in standard combined-modality practice for head and neck squamous cell carcinoma: Analysis of salient surgical and radiotherapy parameters in 2 cohorts. Head Neck 2017; 39:1788-1796. [PMID: 28586138 DOI: 10.1002/hed.24836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC). METHODS Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used. RESULTS Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age ≤ 50 years (P = .041); ≥ 4 positive nodes (P = .029); and overall treatment time (OTT) ≥ 100 days (P = .042). CONCLUSION Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs.
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Affiliation(s)
- Bidhu K Mohanti
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Alok Thakar
- Department of Ear, Nose, and Throat, and Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Jaspreet Kaur
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sudhir Bahadur
- Department of Ear, Nose, and Throat, and Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Monica Malik
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ajeet K Gandhi
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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14
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An Y, Holsinger FC, Husain ZA. De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer. Cancers Head Neck 2016; 1:18. [PMID: 31093347 PMCID: PMC6460758 DOI: 10.1186/s41199-016-0016-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/23/2016] [Indexed: 06/09/2023]
Abstract
Current adjuvant treatment guidelines for oropharyngeal squamous cell carcinoma treated with primary surgery are based on studies that predate the human papillomavirus (HPV) era. HPV-associated oropharynx carcinoma (HPV-OPC) has a much more favorable prognosis compared to HPV-unassociated cancer and is increasingly considered to be a distinct disease entity due to its unique etiology, presentation, and behavior. Currently, there is significant interest in adjuvant treatment de-intensification of HPV-OPC patients in order to reduce treatment-related toxicity while maintaining excellent clinical outcomes. Here, we review the evidence and rationale underlying the ongoing prospective trials of adjuvant treatment de-intensification for HPV-OPC patients.
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Affiliation(s)
- Yi An
- Department of Therapeutic Radiology, Yale University School of Medicine, Smilow Cancer Hospital LL 515, 35 Park St, New Haven, CT 06510 USA
| | - F. Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305 USA
| | - Zain A. Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, Smilow Cancer Hospital LL 515, 35 Park St, New Haven, CT 06510 USA
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15
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Sinha P, Patrik P, Thorstad WL, Gay HA, Haughey BH. Does elimination of planned postoperative radiation to the primary bed in p16-positive, transorally-resected oropharyngeal carcinoma associate with poorer outcomes? Oral Oncol 2016; 61:127-34. [DOI: 10.1016/j.oraloncology.2016.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022]
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