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Imaging, exams detect majority of HPV-positive oropharyngeal cancer recurrences
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Most recurrences of HPV-positive oropharyngeal cancer after treatment with radiation can be detected using imaging and physical exams over 6 months, according to findings presented at the Multidisciplinary Head and Neck Cancer Symposium.
The incidence of HPV-positive oropharyngeal cancer is increasing and survival following definitive radiation therapy has improved. Thus, researchers seek data on the effective detection of recurrence to manage the growing number of survivors.
Jessica M. Frakes, MD
“We wanted to determine when these patients fail and also when they have side effects so we know how to guide our optimal follow-up schedule,” Jessica M. Frakes, MD, assistant member of the department of radiation oncology at H. Lee Moffitt Cancer Center in Tampa, Florida, said during a press briefing.
Frakes and colleagues identified 246 HPV-positive patients who underwent definitive radiotherapy between 2006 and 2014 at Moffitt.
Median follow-up was 36 months.
All patients had PET/CT and physical exams 3 months after treatment and then every 3 months in the first year, every 4 months in the second year and every 6 months in years 3 through 5.
Overall, 97.8% of patients achieved 3-year local control. There were six local failures, all of which were detected by a physical exam.
Regional control was 95.3% at 3 years. Eighty-nine percent of the failures were found due to symptoms or imaging at 3 months after treatment.
“We also wanted to see which patients were at higher risk for regional failure,” Frakes said. “What we found was that patients with five or more lymph nodes or level 4 low-neck lymph nodes present were more likely to suffer regional failure.”
The distant control rate at 3 years was 91%. Researchers detected 71% of distant metastases due to presentation of symptoms or imaging 3 months after treatment.
Researchers observed similar risk factors for distant failure. These included tumors in the lymph nodes larger than 6 cm, bilateral lymph nodes, five or more positive lymph nodes or the presence of level 4 low-neck lymph nodes at diagnosis.
Grade 3 or higher late toxicity occurred in 9% of patients; however, most of those were resolved by the last follow-up, equating to an overall toxicity rate of 2%.
“The majority of recurrences and toxicities can be detected by posttreatment imaging at 3 months and physical exams during that first 6 months following treatment,” Frakes said. “Regardless if those patients were at higher risk for regional or distant failures, they had that same time course of toxicity or recurrence.”
The researchers concluded that minimizing tests that do not compromise outcomes will not only help reduce anxiety and stress for patients, but will also ease the financial burden of care. – by Anthony SanFilippo
Reference:
Frakes JM, et al. Abstract 10. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 18-19, 2016; Scottsdale, Ariz.
Disclosure: The researchers report no relevant financial disclosures.