Niazi Muneeb, Miller Ryan, Kolb Ryann, Ji Wenyan, Lozano Alicia, Ahrens Monica, Hanlon Alexandra, Pickles Max, Song Andrew, Bar-Ad Voichita, Hockstein Neil, Park Su Jung, Raben Adam, Shukla Gaurav
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, Virginia.
Adv Radiat Oncol. 2024 Apr 14;9(8):101515. doi: 10.1016/j.adro.2024.101515. eCollection 2024 Aug.
Oropharyngeal squamous cell cancers (OPSCCs) are traditionally managed with surgery and, if indicated, adjuvant radiation therapy (RT) with or without chemotherapy. NCCN recommends keeping the time from surgery to the start of RT (TSRT) within 6 weeks to avoid possibly compromising patient outcomes. HPV+ OPSCCs behave more favorably than HPV- OPSCCs. We hypothesized that TSRT beyond 6 weeks may not portend poorer outcomes for the former.
We identified nonmetastatic, high-risk HPV+ OPSCCs treated with multimodal therapy at 2 institutions. Prolonged TSRT was defined as >6 weeks and was evaluated for association with recurrence-free survival (RFS). Radiation treatment time (RTT; time from the first to the last day of RT), total treatment package time (TTPT; time from surgery to the end of adjuvant treatments), de-escalated RT (dose ≤56 Gy), concurrent chemotherapy, smoking history, and treatment institution were evaluated as possible confounders.
In total, 96 patients were included. The median follow-up time was 62 months (4-123 months); 69 patients underwent transoral robotic surgeries, and 27 received open surgeries. The median postoperative RT dose was 60 Gy (50-70.8 Gy). The median TSRT, RTT, and TTPT were 38 days (11-208), 43 days (26-56 days), and 81 days (40-255 days), respectively. Ten patients failed treatment at a median of 8 months (4-64 months). Two locoregional and 4 distant failures occurred in the group without prolonged TSRT, whereas 2 locoregional and 2 distant failures were recorded in the prolonged TSRT group. Prolonged TTPT, de-escalated RT, chemotherapy, smoking history, and treatment institution were not associated with treatment failure. RTT was dropped from our analyses as no events appeared in the prolonged RTT group, and no reliable hazard ratio could be computed.
TSRT > 6 weeks was not significantly associated with inferior outcomes in the postoperative management of HPV+ OPSCCs. Longer TSRT may facilitate better recovery from surgical toxicity, as needed, without compromising oncologic outcomes. The TSRT goal for these cancers should be investigated in future studies.
口咽鳞状细胞癌（OPSCC）传统上采用手术治疗，如有指征，则联合或不联合化疗进行辅助放疗（RT）。美国国立综合癌症网络（NCCN）建议将从手术到开始放疗的时间（TSRT）控制在6周内，以避免可能影响患者的治疗效果。人乳头瘤病毒（HPV）阳性的OPSCC比HPV阴性的OPSCC预后更好。我们假设TSRT超过6周对前者来说可能并不预示着更差的治疗效果。
我们在2家机构中确定了接受多模式治疗的非转移性、高危HPV阳性OPSCC患者。将延长的TSRT定义为>6周，并评估其与无复发生存期（RFS）的相关性。放疗时间（RTT；从放疗第一天到最后一天的时间）、总治疗时间（TTPT；从手术到辅助治疗结束的时间）、减量放疗（剂量≤56 Gy）、同步化疗、吸烟史和治疗机构被评估为可能的混杂因素。
总共纳入了96例患者。中位随访时间为62个月（4 - 123个月）；69例患者接受了经口机器人手术，27例接受了开放手术。术后放疗的中位剂量为60 Gy（50 - 70.8 Gy）。TSRT、RTT和TTPT的中位数分别为38天（11 - 208天）、43天（26 - 56天）和81天（40 - 255天）。10例患者治疗失败，中位时间为8个月（4 - 64个月）。在未延长TSRT的组中发生了2例局部区域复发和4例远处转移，而在延长TSRT的组中记录到2例局部区域复发和2例远处转移。延长TTPT、减量放疗、化疗、吸烟史和治疗机构与治疗失败无关。由于延长RTT组未出现事件，且无法计算可靠的风险比，因此RTT被从我们的分析中剔除。
在HPV阳性OPSCC的术后管理中，TSRT>6周与较差的治疗效果无显著相关性。如有需要，更长的TSRT可能有助于更好地从手术毒性中恢复，而不影响肿瘤学结局。这些癌症的TSRT目标应在未来的研究中进行探讨。
