Outcomes after primary intensity-modulated radiation therapy for oropharyngeal squamous cell carcinoma at a New Zealand regional cancer centre: Impact of p16 status.

INTRODUCTION: The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) in New Zealand is due to an increase in the numbers of human papilloma virus (HPV)-associated OPSCC. We evaluated the impact of positive p16 immunohistochemistry, as a surrogate for HPV positivity, on OPSCC outcomes after primary intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy. METHODS: Retrospective review was undertaken of electronic medical records of 90 patients with OPSCC who received primary IMRT with or without chemotherapy between 2008 and mid-2015 at the Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand. RESULTS: Median age was 57.5 years. Immunohistochemistry for p16 was positive in 53 (59%) OPSCC while 37 (41%) had negative or unknown p16 status. Median radiotherapy dose was 70 Gy. Chemotherapy was administered to 78 (87%) patients, most receiving high-dose cisplatin. Nine patients had residual disease following treatment completion. Seven patients relapsed, and 26 died during the study period. Five patients with p16-positive OPSCC had persistent or recurrent disease. Actuarial 3-year locoregional control, disease-free survival, and overall survival for all patients were 80.7%, 74.7%, and 77.1%, respectively. Among p16-positive OPSCC patients, 3-year locoregional control, disease-free survival, and overall survival were 89.5%, 80.8%, and 90.9%, respectively. CONCLUSION: Outcomes after IMRT for OPSCC at Waikato Hospital are in line with the reported literature. Human papilloma virus-related OPSCC has better outcomes compared with patients with unknown or HPV-unrelated OPSCC. Trials are underway evaluating reduced intensity of treatment for HPV-related OPSCC.

Impact of geriatric assessment on the management of older adults with head and neck cancer: A pilot study.

OBJECTIVE: Assess the utility of the G8 screening tool and CGA for older adults with head and neck cancer. METHODS: Patients 65years or older with a primary malignancy of the head and neck region were presented at the multidisciplinary team (MDT) meeting. The Geriatric 8 (G8) questionnaire was administered prior. Clinicians, blinded to the G8 result, made a recommendation on appropriate treatment, including potential referral for CGA. Patients considered vulnerable (G8 score≤14) were also to be referred for CGA. Treatment outcomes were recorded. RESULTS: Over 6months, 35 patients were recruited, median age 74 (range 65-93). Seventeen (49%) patients were assessed as vulnerable by the G8 score, including 7 (20%) whom the MDT referred for CGA. Seven with G8 scores≤14 did not receive a CGA. Thirty (85.7%) underwent curative intent treatment, including 6 of 7 who had CGA. Of 10 vulnerable patients who did not have CGA, 70% received curative-intent treatment. Mean length of post-operative stay was 12.2 vs. 6.5days in patients deemed vulnerable or fit by G8 scores, respectively (p=0.46); completion rate of radical radiotherapy was 75% vs. 100% in each group, respectively (p=0.13). Mean post-operative length of stay in vulnerable patients who underwent a CGA was 6.2days vs. 17.3days in those who were not referred (p=0.79). CONCLUSIONS: The G8 tool identified twice the number of patients as vulnerable compared to the MDT. There was a trend towards longer postoperative stay and lower radiotherapy completion rates in patients deemed vulnerable by G8 scores.