Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania.
Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2020 Apr;130(4):E171-E176. doi: 10.1002/lary.28083. Epub 2019 May 23.
OBJECTIVES/HYPOTHESIS: Numerous trials are evaluating radiotherapy (RT) de-escalation for human papillomavirus (HPV)-mediated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Herein, we evaluated the degree to which de-escalated RT is delivered in the United States, as well as comparative outcomes with full-dose RT as stratified for HPV status.
Retrospective database review.
We identified patients diagnosed with OPSCC in the National Cancer Database, excluding those with stage I/II disease, unknown HPV status, receiving surgery or not receiving external beam radiation therapy to the primary site, receipt of radiation doses >75 or <54 Gy, radiation treatment course duration <25 or >75 days, and unknown or inadequate (<2 months) follow-up. Multivariable logistic regression analysis identified variables associated with delivery of de-escalated RT (<66 Gy). Overall survival of HPV+ and non-HPV-mediated (HPV-) disease was compared between full-dose and de-escalated approaches.
Altogether, 617 and 551 patients were HPV+ and HPV-, respectively. De-escalated RT was delivered in 16.9% HPV+ and 15.2% of HPV- disease, respectively. Older patients and omission of systemic therapy were more likely to receive de-escalated RT. In HPV+ patients, 3- and 5-year survival rates were 83% and 80% in the de-escalated cohort versus 83% and 78% in the full-dose group (P = .83). In HPV- patients, corresponding 3- and 5-year survival rates were 29% and 23% versus 61% and 51% (P = .001).
National utilization of de-escalated RT for OPSCC is low (15%-20%), but does not seem to impact overall survival in HPV+ (but not HPV-) patients. The caveats of this heterogeneous, retrospective analysis require corroboration from a number of ongoing randomized trials.
2c Laryngoscope, 130:E171-E176, 2020.
目的/假设：许多试验正在评估人乳头瘤病毒（HPV）介导的（HPV+）口咽鳞状细胞癌（OPSCC）的放疗（RT）降阶。在此，我们评估了 RT 降阶在美国的实施程度，并按 HPV 状态分层比较了与全剂量 RT 的比较结果。
回顾性数据库研究。
我们从国家癌症数据库中确定了 OPSCC 患者，排除了 I 期/II 期疾病、HPV 状态未知、未接受手术或未接受原发部位外照射放疗、接受放射剂量>75 或<54 Gy、放射治疗疗程<25 或>75 天以及未知或不充分（<2 个月）随访的患者。多变量逻辑回归分析确定了与 RT 降阶（<66 Gy）相关的变量。HPV+和非 HPV 介导（HPV-）疾病的总生存率在全剂量和降阶方法之间进行了比较。
共有 617 例 HPV+和 551 例 HPV-患者。分别有 16.9%的 HPV+和 15.2%的 HPV-患者接受了 RT 降阶。年龄较大的患者和省略系统治疗的患者更有可能接受 RT 降阶。在 HPV+患者中，3 年和 5 年生存率分别为 83%和 80%，在降阶组；全剂量组为 83%和 78%（P = 0.83）。在 HPV-患者中，相应的 3 年和 5 年生存率分别为 29%和 23%，61%和 51%（P = 0.001）。
美国 OPSCC 患者 RT 降阶的使用率较低（15%-20%），但似乎不会影响 HPV+（但不是 HPV-）患者的总体生存率。这项异质性、回顾性分析存在局限性，需要来自多项正在进行的随机试验的证实。
2c 喉镜，130：E171-E176，2020 年。
