HPV+ oropharyngeal cancer: extranodal extension portends poor distant control

  • Billfalk-Kelly A & al.
  • Int J Radiat Oncol Biol Phys
  • 3 Apr 2019

  • curated by Brian Richardson, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Radiologic extranodal extension (rENE) is associated with poor distant control (DC) and survival in patients with cN+ TNM8 stage I HPV-positive oropharyngeal cancer (OPC) treated with definitive intensity-modulated radiotherapy (IMRT).

Why this matters

  • Identification of radiologic features predicting poor prognosis may help with patient management.

Key results

  • Patients with rENE had reduced 5-year DC, DFS, and OS compared with patients without rENE (78% vs 95% [P<.001 vs respectively>
  • Patients with and without rENE had similar locoregional control (93% vs 97%; P=.34).
  • In subgroup analysis, rENE was associated with reduced DC and DFS in patients treated with IMRT alone (N=85; 74% vs 96% [P=.029] and 45% vs 83% [P=.014], respectively) and those treated with IMRT plus systemic agents (N=195; 79% vs 95% [P=.001] and 63% vs 92% [P<.001 respectively>
  • rENE (HR, 4.3, P<.001 t2 category vs t1 and smoking pack-years were associated with poor dfs in multivariate analysis whereas addition of systemic agents was improved dfs.>

Study design

  • 280 patients with HPV-positive cT1-T2cN1 OPC treated with definitive IMRT, 45 with rENE, were analyzed for outcomes.
  • Funding: None

Limitations

  • Retrospective study.

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