International Journal of
Radiation Oncology biology
physics
www.redjournal.org
Human Papillomavirus and Head and Neck Cancer By Randall J. Kimple, MD, PhD, and David J. Sher, MD, MPH, Associate Editors
The last decade has produced a sea change in treatment of and prognosis for head and neck oncogenesis. In this edition of the International Journal of Radiation Oncology, Biology, Physics, like previous Oncology Scan articles (1-4), we review 4 recent Radiation Therapy Oncology Group (RTOG) publications that significantly add to our understanding of the prognostic importance of human papillomavirus (HPV) infection in head and neck cancer.
Fakhry et al. Human papillomavirus and overall survival after progression of oropharyngeal squamous cell carcinoma. J Clin Oncol 2014. (5) Summary: Much has been written about the improved outcomes following an initial presentation with HPVpositive oropharyngeal cancer (OPC). Less has been reported about survival following recurrence, especially in a prospectively enrolled population. Filling this void, Fakhry et al (5) report on nearly 200 OPC patients with available p16 immunohistochemistry (IHC) results whose cancer recurred after they received platinum-based chemoradiation in 2 RTOG trials, 0129 and 0522. One of the more straightforward but important conclusions from this analysis is that when p16-positive patients progress, their initial presentation of recurrence parallels that in p16-negative individuals. The median time to disease progression was similar in both p16-positive and p16negative patients (8.2 vs 7.3 months, respectively; PZ.67), and the majority of patients had recurrence in the first 2 years (82% vs 86%, respectively). In addition, the patterns of disease progression (ie locoregional vs distant) were also similar for the 2 groups, as were the specific locations of metastatic spread (ie lung vs bone vs liver vs other site). Although there are many anecdotal reports of unusual recurrences in HPVpositive disease, these prospectively collected data suggest that in general, p16 status does not inform the time and place of progression, just its likelihood. Comment: The most dramatic findings of the study were significant differences between overall survival (OS) in Int J Radiation Oncol Biol Phys, Vol. 92, No. 2, pp. 196e199, 2015 0360-3016/$ - see front matter http://dx.doi.org/10.1016/j.ijrobp.2015.01.015
p16-positive cancers and those in p16-negative cancers (median OS of 2.6 years vs 0.8 year from time of progression, with 2-year OS probabilities of 54.6% vs 27.6%, respectively; P
Radiation Oncology biology
physics
www.redjournal.org
Human Papillomavirus and Head and Neck Cancer By Randall J. Kimple, MD, PhD, and David J. Sher, MD, MPH, Associate Editors
The last decade has produced a sea change in treatment of and prognosis for head and neck oncogenesis. In this edition of the International Journal of Radiation Oncology, Biology, Physics, like previous Oncology Scan articles (1-4), we review 4 recent Radiation Therapy Oncology Group (RTOG) publications that significantly add to our understanding of the prognostic importance of human papillomavirus (HPV) infection in head and neck cancer.
Fakhry et al. Human papillomavirus and overall survival after progression of oropharyngeal squamous cell carcinoma. J Clin Oncol 2014. (5) Summary: Much has been written about the improved outcomes following an initial presentation with HPVpositive oropharyngeal cancer (OPC). Less has been reported about survival following recurrence, especially in a prospectively enrolled population. Filling this void, Fakhry et al (5) report on nearly 200 OPC patients with available p16 immunohistochemistry (IHC) results whose cancer recurred after they received platinum-based chemoradiation in 2 RTOG trials, 0129 and 0522. One of the more straightforward but important conclusions from this analysis is that when p16-positive patients progress, their initial presentation of recurrence parallels that in p16-negative individuals. The median time to disease progression was similar in both p16-positive and p16negative patients (8.2 vs 7.3 months, respectively; PZ.67), and the majority of patients had recurrence in the first 2 years (82% vs 86%, respectively). In addition, the patterns of disease progression (ie locoregional vs distant) were also similar for the 2 groups, as were the specific locations of metastatic spread (ie lung vs bone vs liver vs other site). Although there are many anecdotal reports of unusual recurrences in HPVpositive disease, these prospectively collected data suggest that in general, p16 status does not inform the time and place of progression, just its likelihood. Comment: The most dramatic findings of the study were significant differences between overall survival (OS) in Int J Radiation Oncol Biol Phys, Vol. 92, No. 2, pp. 196e199, 2015 0360-3016/$ - see front matter http://dx.doi.org/10.1016/j.ijrobp.2015.01.015
p16-positive cancers and those in p16-negative cancers (median OS of 2.6 years vs 0.8 year from time of progression, with 2-year OS probabilities of 54.6% vs 27.6%, respectively; P
