Presentation: A102
Topic: Oropharynx / HPV Related Disease
Type: Poster
Authors: Melina J Windon, MD1; Eleni M Rettig, MD2; Carole Fakhry, Professor1
Institution(s): 1Johns Hopkins University SOM; 2Brigham and Women's Hospital


Recent decades exhibit a changing landscape of head and neck squamous cell carcinoma (HSNCC) and its treatment. The landmark Department of Veteran’s Affairs trial, the appreciation of the role of human papillomavirus in HNSCC epidemiology and prognosis, adoption of robotic techniques in transoral surgery, and the improvements in radiation therapy techniques underlie the most prominent shifts. Trends in surgical and non-surgical primary curative treatment for HNSCC over this time period, however, have not been described.

Methods: This is a retrospective cohort study of incident cases of HNSCC from 2004-2017 included in the National Cancer Database, a hospital-based cancer registry in the United States. Incident cases of HNSCC from 2004-2017 with available treatment data who received either radiation or surgical treatment with curative intent were included. The association of primary radiation therapy rather than primary surgical therapy was examined across demographic and disease data by chi-squared tests and multivariable logistic regression. Trends over time were described using linear regression (annual percent change, APC) and compared using nonparametric tests for trend.

Results: Of 310,633 HNSCC cases in the dataset,  37.6% received primary surgical therapy whereas 62.4% received radiation therapy. After adjustment, receipt of radiation was significantly associated with nonacademic treatment facility (aOR=2.33, 95%CI 2.27-2.38), closer distance to treatment facility (aOR=1.85, 95%CI 1.82-1.92), node-positive disease (aOR=2.18, 95%CI 2.14-2.23), and oropharynx, larynx, hypopharynx, or nasopharynx primary site, among other factors.

Among HNSCC from 2004-2017, there was an increase in primary surgical therapy (APC=0.6 [95% CI 0.6-0.7] per year), which persisted after adjustment (aAPC=1.0 [95% CI 1.0-1.1]). This trend was limited to non-oropharyngeal cancers (aAPC=1.1 [95% CI 1.1-1.2]), as treatment patterns remained stable for oropharyngeal cancers. When the analysis was limited to oropharyngeal cancers with available HPV tumor status (2010-2017 only), the proportion of cases treated with primary radiation therapy increased for both HPV-positive and HPV-negative tumors over time. This trend was more significant for HPV-positive tumors (aAPC=1.1 [95%CI 0.8-1.3] versus 0.3 [95%CI 0.0-0.5%=], p<0.001).

Conclusion: Though the proportion of HNSCC cases treated with primary curative surgical therapy increased since 2004, treatment for oropharyngeal cancers has trended toward radiation in recent calendar years. The rate of primary curative radiation therapy increased for all oropharyngeal cancers from 2010-2017, a trend which is significantly more pronounced for those with HPV positive tumor status. These nationwide trends contextualize current treatment decisions and inform ongoing paradigm shifts about treatment deintensification for oropharyngeal cancers with low risk of recurrence.