Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada.
Joint Department of Biostatistics, Princess Margaret Cancer Centre, Room 10-508, 610 University Ave, Toronto, ON M5G 2M9, Canada.
Oral Oncol. 2019 Oct;97:124-130. doi: 10.1016/j.oraloncology.2019.05.012. Epub 2019 Sep 11.
To evaluate outcomes in oropharyngeal cancer (OPC) patients who did not complete their planned curative radiation therapy (RT).
OPC Patients who received less than planned curative RT dose between 2002 and 2016 were identified for analysis. HPV status was assessed. Radiation dose was normalized for fractionation variations using biological effective doses assuming tumor α/β = 10 Gy [BED10]. Outcomes were compared using BED10. Multivariable and univariable analysis identified OS predictors.
From a total of 80 patients who did not complete therapy, 64 patients were eligible for analysis. RT incompletion was due to: RT side effects (n = 23), patients' decision (n = 21), disease progression or metastases (n = 3), and other causes (n = 7). Median BED10 (Gy) was 56.2 for the HPV-positive and 58 for the HPV-negative. Three-year OS was 74% vs 13% (p < 0.001) for the HPV-positive (n = 29) and HPV-negative (n = 24), respectively. HPV-positive patients who received BED10 ≥55 had higher OS than those received BED10 <55 (94% vs 47%, p = 0.002) while no difference in OS by BED10 ≥55 vs <55 for the HPV-negative (12 vs 13%, p = NS). HPV-positive status was associated with a higher OS (HR 12.5, 95% CI, 4.54 to 33.3, p < 0.001). A total of 37 patients were available to estimate TD for local control assessment. TD (BED10) was estimated at 60.5 Gy for HPV-negative patients compared to 27.2 Gy for HPV-positive patients.
Overall, in patients with incomplete treatment, HPV-positive OPC patients demonstrated a better OS compared to HPV-negative patients. HPV-positive patients who received BED10 ≥55 have higher rates of OS.
评估未完成计划根治性放疗（RT）的口咽癌（OPC）患者的结局。
分析了 2002 年至 2016 年间接受的计划根治性 RT 剂量少于计划剂量的 OPC 患者。评估 HPV 状态。使用假设肿瘤 α/β=10Gy [BED10]的生物有效剂量对分割变化进行归一化，以评估辐射剂量。使用 BED10 比较结果。多变量和单变量分析确定了 OS 预测因素。
在总共 80 名未完成治疗的患者中，有 64 名患者符合分析条件。RT 不完成的原因包括：RT 副作用（n=23）、患者决定（n=21）、疾病进展或转移（n=3）和其他原因（n=7）。HPV 阳性患者的中位 BED10（Gy）为 56.2，HPV 阴性患者为 58。HPV 阳性（n=29）和 HPV 阴性（n=24）患者的 3 年 OS 分别为 74%和 13%（p<0.001）。接受 BED10≥55 的 HPV 阳性患者的 OS 高于接受 BED10<55 的患者（94% vs 47%，p=0.002），而 HPV 阴性患者的 BED10≥55 与<55 的 OS 无差异（12% vs 13%，p=NS）。HPV 阳性状态与更高的 OS 相关（HR 12.5，95%CI，4.54 至 33.3，p<0.001）。共有 37 名患者可用于局部控制评估的 TD 估计。HPV 阴性患者的 TD（BED10）估计为 60.5Gy，而 HPV 阳性患者为 27.2Gy。
总体而言，在治疗不完整的患者中，HPV 阳性 OPC 患者的 OS 优于 HPV 阴性患者。接受 BED10≥55 的 HPV 阳性患者的 OS 更高。
