METASTECTOMY FOR DELAYED DISTANT METASTASIS IN HUMAN PAPILLOMAVIRUS-ASSOCIATED OROPHARYNGEAL CARCINOMA

Presentation: B101
Topic: Oropharynx / Significance of HPV on Cancer Treatment and Survival
Type: Poster
Date:
Session:
Authors: William G Albergotti, MD, Ronak Dixit, MD, Robert L Ferris, MD, PhD, Jonas T Johnson, MD, PhD, Umamaheswar Duvvuri, MD, PhD, Seungwon Kim, MD, PhD
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Institution(s): University of Pittsburgh Medical Center
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Background: Human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is associated with a known better prognosis.  However, distant metastasis occurs in up to 10% of these patients and is associated with poor prognosis.  Metastectomy is not typically used in head and neck cancer due to previous reports suggesting no added benefit to patient survival.  It has not been reported upon in HPV+ OPSCC.

Methods: A retrospective review was performed of all HPV+ OPSCC treated at the University of Pittsburgh Medical Center from 1980 – 2015 with at least one year of follow-up.  Charts of patients who developed distant metastasis after primary treatment were reviewed.  All patients who underwent metastectomy with curative intent were included.  Charts were queried for presenting demographics, initial and subsequent treatments, overall and disease-free survival after metastectomy. 

Results: 7 patients underwent metastectomy for presumed oligometastatic HPV+ OPSCC. 5/7 patients initially presented with advanced locoregional disease (T3/T4/N2c/N3).  Distant recurrence occurred at a mean of 28 months (range 6 months – 65 months).  6 patients had one site of distant recurrence while 1 patient had two metastases, all within the lung.  All metastases were resected with negative margins with 5/7 tested and positive for HPV/p16.  1 patient was found to have carinal lymph node metastasis time of metastatectomy.  5 patients received no further treatment while 1 patient received stereotactic radiosurgery and 1 patient was treated with induction followed by maintenance chemotherapy.  3 patients developed further recurrence of disease with 2/3 dying of disease (mean 33 months after metastectomy) and 1 was alive with disease (12 months after metastectomy).  4 patients are alive without evidence for disease at mean 33 months follow-up (range 8 months – 49 months). 

Conclusion: Metastectomy should be strongly considered as a treatment option for patients with oligometastatic HPV+ OPSCC.  Long-term survival may be achieved.