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American Head & Neck Society
Translational Research Meeting

April 21-22, 2015

AHNS Annual Meeting
April 22-23, 2015 during the
Combined Otolaryngology Spring Meetings


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What Predicts Triple Modality Therapy For Patients With T1 And T2 Oropharyngeal Tumors Undergoing Primary Surgical Treatment?

Presentation: S015
Topic: Outcomes
Type: COSM
Date: Wednesday, April 22, 2015
Session: 3:15 PM - 4:00 PM Scientific Session #3
Authors: Benjamin R Roman, MD, MSHP1, Snehal G Patel, MD1, Jatin P Shah, MD1, Marc A Cohen, MD2
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Institution(s): 1Memorial Sloan Kettering Cancer Center, 2Weill Cornell Medical College
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Objective:  

Early T-stage oropharyngeal squamous cell carcinoma may be treated with a primary non-surgical or primary surgical approach, with adjuvant therapy as needed. One potential advantage of selecting patients for a primary surgical approach is the possibility of being able to avoid adjuvant chemotherapy and its sequelae. The objective of this study was to determine the success of the selection process for patients that might be able to avoid chemotherapy, and to determine factors associated with the receipt of adjuvant chemoradiotherapy.

 

Methods:  

This study used a cohort of patients with histologically confirmed oropharyngeal squamous cell carcinoma in the National Cancer Data Base from 1998-2011. Patients were included if they had T1 or T2 tumors and underwent a primary surgical approach with curative intent (e.g. pharyngectomy including tonsillectomy, but not excisional biopsy). Patients were then divided into groups of those receiving no adjuvant therapy, radiation alone, or chemoradiation. For analysis of our primary outcome, patients receiving chemoradiation were separated from the rest.  We used bivariate analysis to determine the association of tumor factors and the year of diagnosis with the receipt of adjuvant chemoradiation. We used multivariable logistic regression to control for tumor factors and year and determine if any other patient factors were predictive of the use of adjuvant chemoradiotherapy.

 

Results:  

3,866 patients with histologically confirmed oropharyngeal SCCA undergoing primary surgical therapy were identified in the NCDB (mean age 56 ± 10 years; 80% male; 92% white). 23% had surgery alone, 31% had adjuvant radiation, and 46% had adjuvant chemoradiation. The percentage of patient undergoing adjuvant chemoradiation increased over time, especially between the years 2004-2009 (see Figure 1). Patients with N0, N1, N2, and N3 disease received adjuvant chemoradiation 17%, 41%, 56%, and 70% of the time, respectively (p<0.0001). Patients with positive extracapsular spread (ECS) or positive margins received adjuvant chemoradiation 68% and 57% of the time, respectively (both p<0.0001). Even controlling for nodal stage, ECS, margin status, and year, patients were more likely to receive adjuvant chemoradiation if they were younger (<50 vs. ≥80: O.R. 9.31, C.I. 2.64-X32.87, p= 0.001), male (O.R. 1.44, C.I. 1.12-1.84, p= 0.004), had private insurance (vs. Medicare or Medicaid: O.R. 1.73, C.I. 1.26-2.39, p= 0.001), or if they went to hospitals treating fewer oropharyngeal cancer patients (1-5 patients vs. >25 patients: O.R. 1.65, C.I. 1.18-2.29, p= 0.003).

 

Conclusion:

Triple modality therapy (surgery plus radiation and chemotherapy) is common in early T-stage oropharyngeal cancer, and non-tumor factors are associated with the addition of chemotherapy. Efforts are warranted to determine appropriate selection for primary surgical treatment and the benefit of adjuvant chemoradiation, especially in the era of increased HPV-associated disease and increased enthusiasm for trans-oral approaches to early T-stage disease.

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