Differential response rates to irradiation among patients with human papillomavirus positive and negative oropharyngeal cancer

Allen M. Chen, Judy Li, Laurel A Beckett, Talia Zhara, D Gregory Farwell, Derick H Lau, Regina F Gandour-Edwards, Andrew T M Vaughan, James A. Purdy

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives/Hypothesis: To evaluate the responsiveness of human papillomavirus (HPV) -positive and HPV-negative oropharyngeal cancer to intensity-modulated radiotherapy (IMRT), using axial imaging obtained daily during the course of image-guided radiotherapy (IGRT). Study Design: Observational cohort study with matched-pair analysis of patients irradiated for HPV-positive and HPV-negative oropharygeal cancer. Methods and Materials: Ten patients treated by IMRT to 70 Gy for locally advanced, HPV-positive squamous cell carcinoma of the oropharynx were matched to one HPV-negative control subject by age, gender, performance status, T-category, tumor location, and the use of concurrent chemotherapy. The gross tumor volume (GTV) was delineated on daily IGRT scans obtained via kilovoltage cone-beam computed tomography (CBCT). Mathematical modeling using fitted mixed-effects repeated measure analysis was performed to quantitatively and descriptively assess the trajectory of tumor regression. Results: Patients with HPV-positive tumors experienced a more rapid rate of tumor regression between day 1 of IMRT and the beginning of week 2 (-33% Δ GTV) compared to their counterparts with HPV-negative tumors (-10% Δ GTV), which was statistically significant (p<0.001). During this initial period, the average absolute change in GTV was -22.9 cc/week for HPV-positive tumors and -5.9 cc/week for HPV-negative tumors (p<0.001). After week 2 of IMRT, the rates of GTV regression were comparable between the two groups. Conclusions: HPV-positive oropharyngeal cancers exhibited an enhanced response to radiation, characterized by a dramatically more rapid initial regression than those with HPV-negative tumors. Implications for treatment de-intensification in the context of future clinical trials and the possible mechanisms underlying this increased radiosensitivity will be discussed. Laryngoscope, 2013

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalLaryngoscope
Volume123
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Oropharyngeal Neoplasms
Intensity-Modulated Radiotherapy
Tumor Burden
Neoplasms
Image-Guided Radiotherapy
Laryngoscopes
Matched-Pair Analysis
Oropharynx
Cone-Beam Computed Tomography
Radiation Tolerance
Observational Studies
Squamous Cell Carcinoma

Keywords

  • head and neck cancer
  • Human papillomavirus
  • Level of Evidence: 3B
  • radiation therapy
  • radiosensitivity
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{792328ffc11d485d804d55c065f95aa6,
title = "Differential response rates to irradiation among patients with human papillomavirus positive and negative oropharyngeal cancer",
abstract = "Objectives/Hypothesis: To evaluate the responsiveness of human papillomavirus (HPV) -positive and HPV-negative oropharyngeal cancer to intensity-modulated radiotherapy (IMRT), using axial imaging obtained daily during the course of image-guided radiotherapy (IGRT). Study Design: Observational cohort study with matched-pair analysis of patients irradiated for HPV-positive and HPV-negative oropharygeal cancer. Methods and Materials: Ten patients treated by IMRT to 70 Gy for locally advanced, HPV-positive squamous cell carcinoma of the oropharynx were matched to one HPV-negative control subject by age, gender, performance status, T-category, tumor location, and the use of concurrent chemotherapy. The gross tumor volume (GTV) was delineated on daily IGRT scans obtained via kilovoltage cone-beam computed tomography (CBCT). Mathematical modeling using fitted mixed-effects repeated measure analysis was performed to quantitatively and descriptively assess the trajectory of tumor regression. Results: Patients with HPV-positive tumors experienced a more rapid rate of tumor regression between day 1 of IMRT and the beginning of week 2 (-33{\%} Δ GTV) compared to their counterparts with HPV-negative tumors (-10{\%} Δ GTV), which was statistically significant (p<0.001). During this initial period, the average absolute change in GTV was -22.9 cc/week for HPV-positive tumors and -5.9 cc/week for HPV-negative tumors (p<0.001). After week 2 of IMRT, the rates of GTV regression were comparable between the two groups. Conclusions: HPV-positive oropharyngeal cancers exhibited an enhanced response to radiation, characterized by a dramatically more rapid initial regression than those with HPV-negative tumors. Implications for treatment de-intensification in the context of future clinical trials and the possible mechanisms underlying this increased radiosensitivity will be discussed. Laryngoscope, 2013",
keywords = "head and neck cancer, Human papillomavirus, Level of Evidence: 3B, radiation therapy, radiosensitivity, squamous cell carcinoma",
author = "Chen, {Allen M.} and Judy Li and Beckett, {Laurel A} and Talia Zhara and Farwell, {D Gregory} and Lau, {Derick H} and Gandour-Edwards, {Regina F} and Vaughan, {Andrew T M} and Purdy, {James A.}",
year = "2013",
month = "1",
doi = "10.1002/lary.23570",
language = "English (US)",
volume = "123",
pages = "152--157",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Differential response rates to irradiation among patients with human papillomavirus positive and negative oropharyngeal cancer

AU - Chen, Allen M.

AU - Li, Judy

AU - Beckett, Laurel A

AU - Zhara, Talia

AU - Farwell, D Gregory

AU - Lau, Derick H

AU - Gandour-Edwards, Regina F

AU - Vaughan, Andrew T M

AU - Purdy, James A.

PY - 2013/1

Y1 - 2013/1

N2 - Objectives/Hypothesis: To evaluate the responsiveness of human papillomavirus (HPV) -positive and HPV-negative oropharyngeal cancer to intensity-modulated radiotherapy (IMRT), using axial imaging obtained daily during the course of image-guided radiotherapy (IGRT). Study Design: Observational cohort study with matched-pair analysis of patients irradiated for HPV-positive and HPV-negative oropharygeal cancer. Methods and Materials: Ten patients treated by IMRT to 70 Gy for locally advanced, HPV-positive squamous cell carcinoma of the oropharynx were matched to one HPV-negative control subject by age, gender, performance status, T-category, tumor location, and the use of concurrent chemotherapy. The gross tumor volume (GTV) was delineated on daily IGRT scans obtained via kilovoltage cone-beam computed tomography (CBCT). Mathematical modeling using fitted mixed-effects repeated measure analysis was performed to quantitatively and descriptively assess the trajectory of tumor regression. Results: Patients with HPV-positive tumors experienced a more rapid rate of tumor regression between day 1 of IMRT and the beginning of week 2 (-33% Δ GTV) compared to their counterparts with HPV-negative tumors (-10% Δ GTV), which was statistically significant (p<0.001). During this initial period, the average absolute change in GTV was -22.9 cc/week for HPV-positive tumors and -5.9 cc/week for HPV-negative tumors (p<0.001). After week 2 of IMRT, the rates of GTV regression were comparable between the two groups. Conclusions: HPV-positive oropharyngeal cancers exhibited an enhanced response to radiation, characterized by a dramatically more rapid initial regression than those with HPV-negative tumors. Implications for treatment de-intensification in the context of future clinical trials and the possible mechanisms underlying this increased radiosensitivity will be discussed. Laryngoscope, 2013

AB - Objectives/Hypothesis: To evaluate the responsiveness of human papillomavirus (HPV) -positive and HPV-negative oropharyngeal cancer to intensity-modulated radiotherapy (IMRT), using axial imaging obtained daily during the course of image-guided radiotherapy (IGRT). Study Design: Observational cohort study with matched-pair analysis of patients irradiated for HPV-positive and HPV-negative oropharygeal cancer. Methods and Materials: Ten patients treated by IMRT to 70 Gy for locally advanced, HPV-positive squamous cell carcinoma of the oropharynx were matched to one HPV-negative control subject by age, gender, performance status, T-category, tumor location, and the use of concurrent chemotherapy. The gross tumor volume (GTV) was delineated on daily IGRT scans obtained via kilovoltage cone-beam computed tomography (CBCT). Mathematical modeling using fitted mixed-effects repeated measure analysis was performed to quantitatively and descriptively assess the trajectory of tumor regression. Results: Patients with HPV-positive tumors experienced a more rapid rate of tumor regression between day 1 of IMRT and the beginning of week 2 (-33% Δ GTV) compared to their counterparts with HPV-negative tumors (-10% Δ GTV), which was statistically significant (p<0.001). During this initial period, the average absolute change in GTV was -22.9 cc/week for HPV-positive tumors and -5.9 cc/week for HPV-negative tumors (p<0.001). After week 2 of IMRT, the rates of GTV regression were comparable between the two groups. Conclusions: HPV-positive oropharyngeal cancers exhibited an enhanced response to radiation, characterized by a dramatically more rapid initial regression than those with HPV-negative tumors. Implications for treatment de-intensification in the context of future clinical trials and the possible mechanisms underlying this increased radiosensitivity will be discussed. Laryngoscope, 2013

KW - head and neck cancer

KW - Human papillomavirus

KW - Level of Evidence: 3B

KW - radiation therapy

KW - radiosensitivity

KW - squamous cell carcinoma

UR - http://www.scopus.com/inward/record.url?scp=84871716229&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871716229&partnerID=8YFLogxK

U2 - 10.1002/lary.23570

DO - 10.1002/lary.23570

M3 - Article

C2 - 23008061

AN - SCOPUS:84871716229

VL - 123

SP - 152

EP - 157

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 1

ER -