Naik M, Ward M C, Bledsoe T J, Kumar A M S, Rybicki L A, Saxton J P, Burkey B B, Greskovich J F, Adelstein D J, Koyfman S A
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States.
Oral Oncol. 2015 Aug;51(8):800-4. doi: 10.1016/j.oraloncology.2015.04.008. Epub 2015 May 11.
Long term swallowing dysfunction in patients with oropharynx squamous cell carcinoma (OPSCC) treated with concurrent chemoradiation (CRT) is declining. While the use of intensity modulated radiotherapy (IMRT) is commonly believed to be a potential cause, we hypothesize that the increasing incidence of human papillomavirus (HPV) related disease may also favorably impact this outcome.
We reviewed 130 HPV+ and 17 HPV- patients with stage III-IV OPSCC treated exclusively with conventional 3-field radiotherapy with chemotherapy between 2002 and 2010. The rates of normal diet, limited diet (significant restrictions in the types of foods eaten, and/or requiring nutritional supplementation for weight maintenance) and feeding tube dependence (FTD) were compared between HPV+ and HPV- patients. Cox proportional hazards modeling were used to perform univariate analysis (UVA) to examine predictors of a combined endpoint of dietary limitation, which included limited diet and/or FTD. These outcomes were also compared to our previously reported cohort of OPSCC patients treated between 1989 and 2002 to assess changes in toxicity over time given the changing disease epidemiology, in the setting of identical treatment regimens.
With a median follow-up of 55 months, HPV+ patients more frequently had resumed a normal diet (87% vs. 65%) at last follow up and had lower rates of limited diet (9% vs. 18%) and FTD (4% vs. 18%) compared to HPV- patients (p=0.02). HPV status was the only significant predictor of reduced swallowing dysfunction on UVA (HR 0.19; p=0.008). When compared to our 1989-2002 cohort, patients treated between 2002 and 2010 had less FTD (7.5% vs. 34%, p<0.001) and dietary limitations (26% vs.46%, p<0.001) at 6 months post treatment.
HPV+ patients with OPSCC have reduced late swallowing dysfunction after chemoradiation compared to HPV- patients. The changing epidemiology of OPSCC may play a role in toxicity reduction in these patients, independent of the increasing use of IMRT.
接受同步放化疗（CRT）的口咽鳞状细胞癌（OPSCC）患者的长期吞咽功能障碍正在减少。虽然人们普遍认为使用调强放疗（IMRT）是一个潜在原因，但我们推测人乳头瘤病毒（HPV）相关疾病发病率的上升也可能对这一结果产生有利影响。
我们回顾了2002年至2010年间130例HPV阳性和17例HPV阴性的III-IV期OPSCC患者，这些患者仅接受了常规三野放疗联合化疗。比较了HPV阳性和HPV阴性患者的正常饮食率、有限饮食率（饮食类型有显著限制，和/或需要营养补充以维持体重）和依赖饲管进食（FTD）率。采用Cox比例风险模型进行单因素分析（UVA），以检验饮食限制综合终点的预测因素，该终点包括有限饮食和/或FTD。这些结果还与我们之前报告的1989年至2002年间接受治疗的OPSCC患者队列进行了比较，以评估在相同治疗方案背景下，鉴于疾病流行病学的变化，毒性随时间的变化情况。
中位随访55个月时，与HPV阴性患者相比，HPV阳性患者在最后一次随访时更频繁地恢复了正常饮食（87%对65%），有限饮食率（9%对18%）和FTD率（4%对18%）更低（p=0.02）。在UVA中，HPV状态是吞咽功能障碍减轻的唯一显著预测因素（HR 0.19；p=0.008）。与我们1989-2002年的队列相比，2002年至2010年间接受治疗的患者在治疗后6个月时FTD较少（7.5%对34%，p<0.001），饮食限制也较少（26%对46%，p<0.001）。
与HPV阴性患者相比，HPV阳性的OPSCC患者在放化疗后晚期吞咽功能障碍减轻。OPSCC流行病学的变化可能在这些患者的毒性降低中起作用，这与IMRT使用的增加无关。
