Does Age Impact Outcomes of Oropharyngeal squamous cell carcinoma?
Ghanem AI, Schymick MA, Bachiri S, Khalil R, Burmeister C, Sheqwara J, Chang S, Ghanem T, and Siddiqui F. Does Age Impact Outcomes of Oropharyngeal squamous cell carcinoma? International Journal of Radiation Oncology Biology Physics 2020; 106(5):1141.
Int J Radiat Oncol Biol Phys
Purpose/Objective(s): It is well-established that human papilloma virus (HPV) positive (+ve) oropharyngeal (OP) squamous cell carcinoma (SCC) carries a better overall prognosis than HPV negative (-ve) tumors. We sought to investigate the impact of age upon survival endpoints for HPV +ve and -ve OP SCC as well as the differences in acute radiotherapy (RT) toxicity. Materials/Methods: We included all OP SCC cases treated definitively between 2010-2017. All cases underwent either surgery ± adjuvant RT; or definitive RT; ± chemotherapy according to the multidisciplinary tumor board decision. After determining p16 status we dichotomized each HPV group by age at diagnosis into old (> or = 65 years) and young (<65 years) sub-groups. Patients' demographics, clinico-pathological data and treatment modalities were compared across age groups for both HPV sub-types. Log-rank test and Kaplan-Meier curves were utilized to measure effect of age on overall (OS), local recurrence free (LRFS) and distant metastases free (DMFS) survival for HPV +ve and -ve. For patients receiving RT we compared weight loss, feeding tube insertion, treatment breaks and hospitalization during RT as parameters for acute toxicity across age groups. Results: We identified 217 OP SCC who fit our inclusion criteria. Seventy percent were HPV+ve, males were 82%, mean age at diagnosis was 61 years, 75% were white, 67% were ever smokers and 54% were frequent/heavy alcohol drinkers. According to AJCC 7th edition, Stages III and IVA formed 87%; however, these were regrouped as stage I (51%) and stage IVA (62%) as prevalent stages for HPV+ve and -ve respectively as per AJCC 8th version. Definitive CRT was utilized in 58% and surgery ± adjuvant therapy in 31% of the study cohort. For HPV+ve sub-group, 31% were old (n=47); whereas they constituted 40% (n=27) of HPV-ve cases. Clinicopathological and treatment characteristics were generally equivalent among age groups except that HPV +ve younger patients had more adequate surgical margins (≥5mm) (78% vs 36%; p=0.03) than old; and HPV-ve old cases had a trend towards more utilization of concomitant cetuximab (30% vs 13%; p=0.09) than younger ones. All endpoints were not significantly different between old vs young HPV+ve cases with 2-year OS and LRFS of (64% vs 59%; p=0.41 and 88% vs 87%; p=0.98 for both respectively). Similar outcomes were observed between study age groups for HPV-ve cases (p>0.05 for all endpoints). Hospitalization during RT was more frequent in old patients (44% vs 28%; p=0.03). Median weight loss during RT was 9.5% (0-22%) vs 9.3% (0-17%) for old vs young (p=0.35) and RT breaks were also non-significant (39% vs 27%, p=0.8). Feeding tubes were inserted after RT initiation in 41% of old and 36% in young (p=0.5). Conclusion: Older patients with OP SCC have equivalent outcomes compared to younger ones irrespective of HPV status. Optimal treatments must be offered following standard of care as determined by a multi-disciplinary group of providers.