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Treatment outcomes and radiotherapy deintensification strategies in human papillomavirus-associated tonsil cancer

 Joongyo Lee  ;  Kangpyo Kim  ;  Kyung Hwan Kim  ;  Ki Chang Keum  ;  Hye Ryun Kim  ;  Min Hee Hong  ;  Eun Chang Choi  ;  Se-Heon Kim  ;  Yoon Woo Koh  ;  Chang Geol Lee 
 RADIATION ONCOLOGY, Vol.17(1) : 209, 2022-12 
Journal Title
Issue Date
Human Papillomavirus Viruses ; Humans ; Papillomavirus Infections* / complications ; Radiotherapy, Adjuvant / methods ; Retrospective Studies ; Tonsillar Neoplasms* / pathology ; Tonsillar Neoplasms* / radiotherapy ; Treatment Outcome
Human papillomavirus ; Radiotherapy ; Tonsil cancer
Background: Human papillomavirus (HPV)-positive tonsil cancer has a better prognosis than HPV-negative tonsil cancer. Deintensification strategies to reduce or avoid radiotherapy (RT) for patients with HPV-associated tonsil cancer have been suggested. This study investigated the treatment outcomes of patients with HPV-associated tonsil cancer and suggested RT deintensification strategies.

Methods: A cohort of 374 patients with HPV-associated tonsil cancer treated with primary surgery or RT between 2008 and 2020 was retrospectively evaluated. Survival and locoregional control rates after primary surgery or RT were analyzed, and propensity score matching was performed to adjust for clinical factors. Pearson's chi-square or Fisher's exact test was used to compare categorical variables, and Student's t-test was used to compare continuous variables. The Kaplan-Meier method and log-rank test were used to assess overall survival, progression-free survival, and locoregional failure (LRF).

Results: No significant differences in survival or LRF were observed between the primary surgery and RT groups. Subgroup analysis was conducted for patients who underwent primary surgery. Advanced pathological N stage, negative contralateral nodes at diagnosis, abutting or positive surgical margins, and no adjuvant RT were independent risk factors for LRF. Advanced pathological T stage was an independent risk factor for LRF in patients who underwent primary surgery without subsequent adjuvant RT. None of the patients with pathological complete remission (CR) after induction chemotherapy died or experienced LRF.

Conclusions: Our study revealed that the outcomes of primary surgery and primary RT in HPV-positive tonsil cancer were similar after adjusting for clinical factors. Primary RT might be considered instead of surgery in patients with advanced pathological T stage. In the case of pathological CR after induction chemotherapy, deintensification for adjuvant RT should be considered.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koh, Yoon Woo(고윤우)
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Kyung Hwan(김경환)
Kim, Se Heon(김세헌)
Kim, Hye Ryun(김혜련) ORCID logo https://orcid.org/0000-0002-1842-9070
Lee, Joongyo(이준교)
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Choi, Eun Chang(최은창)
Hong, Min Hee(홍민희) ORCID logo https://orcid.org/0000-0003-3490-2195
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