Treatment of oropharyngeal squamous cell carcinoma with IMRT: Patterns of failure after concurrent chemoradiotherapy and sequential therapy

D. J. Sher, V. Thotakura, T. A. Balboni, C. M. Norris, R. I. Haddad, M. R. Posner, J. Lorch, L. A. Goguen, D. J. Annino, R. B. Tishler

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC. Design: Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics. Results: One hundred and sixty-three patients were included with 75% presenting with stage IV disease. Fifty-six patients (34%) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86%/89%, 86%/87%, and 88%/93%, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort. Conclusions: IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.

Original languageEnglish (US)
Article numbermdr609
Pages (from-to)2391-2398
Number of pages8
JournalAnnals of Oncology
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2012

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Chemoradiotherapy
Squamous Cell Carcinoma
Radiotherapy
Neoplasm Metastasis
Survival
Therapeutics
Oropharyngeal Neoplasms
Propensity Score
Selection Bias
Retrospective Studies

Keywords

  • Combined modality therapy
  • Head and neck cancer
  • Human papillomavirus
  • Imrt
  • Oropharynx cancer
  • Sequential therapy

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Sher, D. J., Thotakura, V., Balboni, T. A., Norris, C. M., Haddad, R. I., Posner, M. R., ... Tishler, R. B. (2012). Treatment of oropharyngeal squamous cell carcinoma with IMRT: Patterns of failure after concurrent chemoradiotherapy and sequential therapy. Annals of Oncology, 23(9), 2391-2398. [mdr609]. https://doi.org/10.1093/annonc/mdr609

Treatment of oropharyngeal squamous cell carcinoma with IMRT : Patterns of failure after concurrent chemoradiotherapy and sequential therapy. / Sher, D. J.; Thotakura, V.; Balboni, T. A.; Norris, C. M.; Haddad, R. I.; Posner, M. R.; Lorch, J.; Goguen, L. A.; Annino, D. J.; Tishler, R. B.

In: Annals of Oncology, Vol. 23, No. 9, mdr609, 01.09.2012, p. 2391-2398.

Research output: Contribution to journalArticle

Sher, DJ, Thotakura, V, Balboni, TA, Norris, CM, Haddad, RI, Posner, MR, Lorch, J, Goguen, LA, Annino, DJ & Tishler, RB 2012, 'Treatment of oropharyngeal squamous cell carcinoma with IMRT: Patterns of failure after concurrent chemoradiotherapy and sequential therapy', Annals of Oncology, vol. 23, no. 9, mdr609, pp. 2391-2398. https://doi.org/10.1093/annonc/mdr609
Sher, D. J. ; Thotakura, V. ; Balboni, T. A. ; Norris, C. M. ; Haddad, R. I. ; Posner, M. R. ; Lorch, J. ; Goguen, L. A. ; Annino, D. J. ; Tishler, R. B. / Treatment of oropharyngeal squamous cell carcinoma with IMRT : Patterns of failure after concurrent chemoradiotherapy and sequential therapy. In: Annals of Oncology. 2012 ; Vol. 23, No. 9. pp. 2391-2398.
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abstract = "Background: The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC. Design: Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics. Results: One hundred and sixty-three patients were included with 75{\%} presenting with stage IV disease. Fifty-six patients (34{\%}) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86{\%}/89{\%}, 86{\%}/87{\%}, and 88{\%}/93{\%}, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort. Conclusions: IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.",
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T2 - Patterns of failure after concurrent chemoradiotherapy and sequential therapy

AU - Sher, D. J.

AU - Thotakura, V.

AU - Balboni, T. A.

AU - Norris, C. M.

AU - Haddad, R. I.

AU - Posner, M. R.

AU - Lorch, J.

AU - Goguen, L. A.

AU - Annino, D. J.

AU - Tishler, R. B.

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AB - Background: The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC. Design: Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics. Results: One hundred and sixty-three patients were included with 75% presenting with stage IV disease. Fifty-six patients (34%) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86%/89%, 86%/87%, and 88%/93%, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort. Conclusions: IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.

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