University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA.
University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Oral Oncol. 2024 Apr;151:106703. doi: 10.1016/j.oraloncology.2024.106703. Epub 2024 Feb 28.
Guidelines recommend treatment package time < 85 days and time from surgery to radiation initiation < 6 weeks in head and neck cancer patients. However, HPV positive primaries treated with TORS and adjuvant radiotherapy traditionally demonstrate favorable outcomes.
Single center retrospective chart review of patients diagnosed with HPV positive treatment naïve primary squamous cell carcinoma treated with TORS and postoperative radiation therapy with or without Chemotherapy from 2012 to 2022 with data collection from December 2022-April 2023. Kaplan-Meier survival analysis with log-rank testing assessed the impact of time intervalsbetween diagnosis, TORS, radiation initiation and radiation completion on recurrence free and disease specific survival. Univariate Cox proportional hazards regression analysis was performed to identify factors associated with recurrence free and disease specific survival. Subgroup analysis was done with high risk (positive lymph nodes > 5, >1mm extracapsular extension, positive margins) patients who underwent concurrent Chemotherapy.
Of 255 patients (225 males [89 %], average age 58 years, 163 [64 %] high-risk, median follow-up 4.3 years), 22 (8.6 %) had recurrence and 14 died due after disease recurrence.Only radiation length of 5-7 weeks prolonged survival in the entire population. In the high-risk cohort, time from TORS to radiation initiation < 6 weeks improvedrecurrence free survival, while total package time < 14 weeks wasassociated with greater recurrence free and disease specific survival.
指南建议头颈部癌症患者的治疗套餐时间<85 天，从手术到开始放疗的时间<6 周。然而，HPV 阳性的原发性肿瘤采用 TORS 和辅助放疗治疗通常会取得良好的效果。
对 2012 年至 2022 年间采用 TORS 和术后放疗（伴或不伴化疗）治疗 HPV 阳性初治原发性鳞状细胞癌的患者进行单中心回顾性图表分析，数据收集时间为 2022 年 12 月至 2023 年 4 月。采用 Kaplan-Meier 生存分析和对数秩检验评估诊断、TORS、放疗开始和放疗完成之间的时间间隔对无复发生存和疾病特异性生存的影响。采用单变量 Cox 比例风险回归分析识别与无复发生存和疾病特异性生存相关的因素。对接受同期化疗的高危（淋巴结阳性>5，>1mm 包膜外扩展，切缘阳性）患者进行亚组分析。
在 255 例患者（225 例男性[89%]，平均年龄 58 岁，163 例[64%]为高危患者，中位随访 4.3 年）中，有 22 例（8.6%）出现复发，14 例患者因疾病复发后死亡。仅放疗时间为 5-7 周延长了全人群的生存时间。在高危组中，从 TORS 到放疗开始的时间<6 周可改善无复发生存，而总治疗套餐时间<14 周与无复发生存和疾病特异性生存的改善相关。
