Frakes Jessica M, Naghavi Arash O, Demetriou Stephanie K, Strom Tobin J, Russell Jeffery S, Kish Julie A, McCaffrey Judith C, Otto Kristen J, Padhya Tapan A, Harrison Louis B, Trotti Andy M, Caudell Jimmy J
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Cancer. 2016 Feb 15;122(4):634-41. doi: 10.1002/cncr.29782. Epub 2015 Nov 13.
Determining the optimal follow-up for patients can help maximize the use of health care resources. This is particularly true in a growing epidemic such as human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV+OPSCC). The objective of the current study was to evaluate time to disease recurrence or late toxicity in this cohort of patients to optimize patient management.
An institutional database identified 232 patients with biopsy-proven, nonmetastatic HPV+OPSCC who were treated with radiotherapy. A retrospective review was conducted in patients who were followed every 3 months for the first year, every 4 months in year 2, and every 6 months in years 3 to 5. Late toxicity (grade ≥ 3; toxicity was scored based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4]), locoregional control, distant control, and overall survival were assessed.
The median follow-up was 33 months. Based on Radiation Therapy Oncology Group (RTOG) 0129 study risk groupings, patients were either considered to be at low (162 patients; 70%) or intermediate (70 patients; 30%) risk. Concurrent systemic therapy was used in 85% of patients (196 patients). The 3-year locoregional control, distant control, and overall survival rates were 94%, 91%, and 91%, respectively. Late toxicity occurred in 9% of patients (21 patients). Overall, 64% of toxicity and failure events occurred within the first 6 months of follow-up, with a < 2% event incidence noted at each subsequent follow-up. Only 4 patients experienced their first event after 2 years.
HPV+OPSCC has a low risk of disease recurrence and late toxicity after treatment; approximately two-thirds of events occur within the first 6 months of follow-up. These data suggest that it may be reasonable to reduce follow-up in patients with HPV+OPSCC to every 3 months for the first 6 months, every 6 months for the first 2 years, and annually thereafter.
确定患者的最佳随访方案有助于最大限度地利用医疗资源。在人乳头瘤病毒阳性口咽鳞状细胞癌（HPV+OPSCC）这种日益流行的疾病中尤其如此。本研究的目的是评估该队列患者疾病复发或晚期毒性的时间，以优化患者管理。
一个机构数据库识别出232例经活检证实的非转移性HPV+OPSCC患者，这些患者接受了放射治疗。对患者进行回顾性分析，第一年每3个月随访一次，第二年每4个月随访一次，第三至五年每6个月随访一次。评估晚期毒性（≥3级；毒性根据美国国立癌症研究所不良事件通用术语标准[第4版]评分）、局部区域控制、远处控制和总生存率。
中位随访时间为33个月。根据放射治疗肿瘤学组（RTOG）0129研究风险分组，患者被认为处于低风险（162例患者；70%）或中度风险（70例患者；30%）。85%的患者（196例）使用了同步全身治疗。3年局部区域控制率、远处控制率和总生存率分别为94%、91%和91%。9%的患者（21例）出现晚期毒性。总体而言，64%的毒性和失败事件发生在随访的前6个月内，随后每次随访的事件发生率<2%。只有4例患者在2年后出现首次事件。
HPV+OPSCC治疗后疾病复发和晚期毒性风险较低；约三分之二的事件发生在随访的前6个月内。这些数据表明，将HPV+OPSCC患者的随访方案调整为前6个月每3个月一次，前2年每6个月一次，此后每年一次可能是合理的。
