Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Cancer. 2018 Feb 15;124(4):717-726. doi: 10.1002/cncr.31104. Epub 2017 Dec 15.
The growing epidemic of human papillomavirus-positive (HPV+) oropharyngeal cancer and the favorable prognosis of this disease etiology have led to a call for deintensified treatment for some patients with HPV+ cancers. One of the proposed methods of treatment deintensification is the avoidance of chemotherapy concurrent with definitive/adjuvant radiotherapy. To the authors' knowledge, the safety of this form of treatment de-escalation is unknown and the current literature in this area is sparse. The authors investigated outcomes after various treatment combinations stratified by American Joint Committee on Cancer (AJCC) eighth edition disease stage using patients from the National Cancer Data Base.
A retrospective study of 4443 patients with HPV+ oropharyngeal cancer in the National Cancer Data Base was conducted. Patients were stratified into AJCC eighth edition disease stage groups. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.
For patients with stage I disease, treatment with definitive radiotherapy was associated with diminished survival compared with chemoradiotherapy (hazard ratio [HR], 1.798; P = .029), surgery with adjuvant radiotherapy (HR, 2.563; P = .002), or surgery with adjuvant chemoradiotherapy (HR, 2.427; P = .001). For patients with stage II disease, compared with treatment with chemoradiotherapy, patients treated with a single-modality (either surgery [HR, 2.539; P = .009] or radiotherapy [HR, 2.200; P = .030]) were found to have poorer survival. Among patients with stage III disease, triple-modality therapy was associated with improved survival (HR, 0.518; P = .024) compared with treatment with chemoradiotherapy.
Deintensification of treatment from chemoradiotherapy to radiotherapy or surgery alone in cases of HPV+ AJCC eighth edition stage I or stage II disease may compromise patient safety. Treatment intensification to triple-modality therapy for patients with stage III disease may improve survival in this group. Cancer 2018;124:717-26. © 2017 American Cancer Society.
人乳头瘤病毒阳性（HPV+）口咽癌的发病率不断上升，且这种疾病的预后良好，这促使人们呼吁对某些 HPV+癌症患者进行治疗强度降低。治疗强度降低的一种方法是避免在根治性/辅助性放疗中同时使用化疗。据作者所知，这种治疗降级形式的安全性尚不清楚，且该领域的当前文献稀少。作者利用国家癌症数据库中的患者，根据美国癌症联合委员会（AJCC）第八版疾病分期研究了各种治疗组合的结果。
对国家癌症数据库中 4443 例 HPV+口咽癌患者进行回顾性研究。患者按照 AJCC 第八版疾病分期进行分层。进行多变量 Cox 回归和单变量 Kaplan-Meier 分析。
对于 I 期疾病患者，与放化疗相比，单纯放疗治疗（危险比[HR]，1.798；P =.029）、手术加辅助放疗（HR，2.563；P =.002）或手术加辅助放化疗（HR，2.427；P =.001）的生存率降低。对于 II 期疾病患者，与放化疗相比，接受单一模式治疗（手术[HR，2.539；P =.009]或放疗[HR，2.200；P =.030]）的患者生存率更差。对于 III 期疾病患者，与放化疗相比，三联疗法（HR，0.518；P =.024）与生存改善相关。
在 HPV+ AJCC 第八版 I 期或 II 期疾病中，将治疗强度从放化疗降低为单纯放疗或手术可能会危及患者安全。对于 III 期疾病患者，将治疗强度强化为三联疗法可能会改善该组患者的生存。癌症 2018；124：717-26。©2017 美国癌症协会。
