Sadeghi Nader, Mascarella Marco A, Khalife Sarah, Ramanakumar Agnihotram V, Richardson Keith, Joshi Arjun S, Taheri Reza, Fuson Andrew, Bouganim Nathaniel, Siegel Robert
Department of Otolaryngology - Head and Neck Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Research Institute of McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Head Neck. 2020 Aug;42(8):2145-2154. doi: 10.1002/hed.26147. Epub 2020 Mar 25.
Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery-based de-escalation, is under investigation for treatment of HPV-associated oropharynx cancer (OPC).
Prospective cohort of patients with non-metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease-free survival (DFS).
Fifty-five patients were treated with NAC + S and 142 with CCRT. Stage-matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5-year DFS in the NAC + S group was 96.1% (95% CI 90.8-100) compared to 67.6% (95% CI 50.7-84.5) for CCRT (P = .01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent (P < .0001).
NAC + S may be a novel approach for HPV-associated OPC as it provides lower feeding tube dependence and improved survival compared to stage-matched patients undergoing CCRT.
新辅助化疗后手术（NAC + S）是一种基于全身强化联合手术降期的治疗模式，目前正在研究用于治疗人乳头瘤病毒（HPV）相关的口咽癌（OPC）。
将参加NAC + S临床试验的非转移性、p16阳性OPC患者的前瞻性队列与接受同步放化疗（CCRT）的历史队列进行比较，以比较无病生存期（DFS）。
55例患者接受了NAC + S治疗，142例接受了CCRT治疗。接受CCRT的分期匹配患者吸烟和饮酒的频率更高。NAC + S组的5年DFS为96.1%（95%CI 90.8 - 100），而CCRT组为67.6%（95%CI 50.7 - 84.5）（P = 0.01）。治疗后12个月时，接受CCRT的患者中有24.5%依赖鼻饲管，而NAC + S组的患者无一依赖鼻饲管（P < 0.0001）。
与分期匹配的接受CCRT的患者相比，NAC + S可能是一种治疗HPV相关OPC的新方法，因为它能降低鼻饲管依赖并提高生存率。
