Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status
Background Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squ...
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| Veröffentlicht in: | Head & neck 2017-08, Vol.39 (8), p.1680-1688 |
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| container_title | Head & neck |
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| creator | Molony, Peter Kharytaniuk, Natallia Boyle, Seamus Woods, Robbie S. R. O'Leary, Gerard Werner, Reiltin Heffron, Cynthia Feeley, Linda Sheahan, Patrick |
| description | Background
Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).
Methods
We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease‐specific survival (DSS) was studied according to p16 status.
Results
Twenty‐one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16‐negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16‐positive disease, margin status had no impact on DSS.
Conclusion
Patients with p16‐positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group. |
| doi_str_mv | 10.1002/hed.24824 |
| format | Article |
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Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).
Methods
We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease‐specific survival (DSS) was studied according to p16 status.
Results
Twenty‐one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16‐negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16‐positive disease, margin status had no impact on DSS.
Conclusion
Patients with p16‐positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.</description><identifier>ISSN: 1043-3074</identifier><identifier>EISSN: 1097-0347</identifier><identifier>DOI: 10.1002/hed.24824</identifier><identifier>PMID: 28560813</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - surgery ; Carcinoma, Squamous Cell - virology ; Chemoradiotherapy ; Dysplasia ; Head & neck cancer ; Human papillomavirus ; Human papillomavirus 16 - isolation & purification ; Humans ; Kaplan-Meier Estimate ; Male ; margins ; Margins of Excision ; Middle Aged ; Neck ; Neoplasm Recurrence, Local ; Oropharyngeal Neoplasms - mortality ; Oropharyngeal Neoplasms - surgery ; Oropharyngeal Neoplasms - virology ; oropharynx ; p16 ; Papillomavirus Infections - complications ; Plastic surgery ; Radiation therapy ; Retrospective Studies ; Risk Factors ; Squamous cell carcinoma ; Throat cancer ; Treatment Outcome</subject><ispartof>Head & neck, 2017-08, Vol.39 (8), p.1680-1688</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4194-4b920970cf0d947812fb77d9aaefe0a7494a8ce972605167eb30518decd7409e3</citedby><cites>FETCH-LOGICAL-c4194-4b920970cf0d947812fb77d9aaefe0a7494a8ce972605167eb30518decd7409e3</cites><orcidid>0000-0002-9153-8951</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhed.24824$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhed.24824$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28560813$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Molony, Peter</creatorcontrib><creatorcontrib>Kharytaniuk, Natallia</creatorcontrib><creatorcontrib>Boyle, Seamus</creatorcontrib><creatorcontrib>Woods, Robbie S. R.</creatorcontrib><creatorcontrib>O'Leary, Gerard</creatorcontrib><creatorcontrib>Werner, Reiltin</creatorcontrib><creatorcontrib>Heffron, Cynthia</creatorcontrib><creatorcontrib>Feeley, Linda</creatorcontrib><creatorcontrib>Sheahan, Patrick</creatorcontrib><title>Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status</title><title>Head & neck</title><addtitle>Head Neck</addtitle><description>Background
Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).
Methods
We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease‐specific survival (DSS) was studied according to p16 status.
Results
Twenty‐one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16‐negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16‐positive disease, margin status had no impact on DSS.
Conclusion
Patients with p16‐positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.</description><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Carcinoma, Squamous Cell - virology</subject><subject>Chemoradiotherapy</subject><subject>Dysplasia</subject><subject>Head & neck cancer</subject><subject>Human papillomavirus</subject><subject>Human papillomavirus 16 - isolation & purification</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>margins</subject><subject>Margins of Excision</subject><subject>Middle Aged</subject><subject>Neck</subject><subject>Neoplasm Recurrence, Local</subject><subject>Oropharyngeal Neoplasms - mortality</subject><subject>Oropharyngeal Neoplasms - surgery</subject><subject>Oropharyngeal Neoplasms - virology</subject><subject>oropharynx</subject><subject>p16</subject><subject>Papillomavirus Infections - complications</subject><subject>Plastic surgery</subject><subject>Radiation therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Squamous cell carcinoma</subject><subject>Throat cancer</subject><subject>Treatment Outcome</subject><issn>1043-3074</issn><issn>1097-0347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEFLwzAYhoMobk4P_gEJeNFDty9p1jRHmVMHAy96Lmmabh1t0yWtsn9vareL4OkLycOb93sQuiUwJQB0ttXZlLKYsjM0JiB4ACHj5_2ZhUEInI3QlXM7AAgjRi_RiMbzCGISjtFmVTVStdjkuDGuaIsvjStpN0XtsKmx6VplKu36d2NNs5X2UG-0LLHbd7IyncNKlyVW0qqiNpXEUiljs6Le4NbghkTYtbLt3DW6yGXp9M1xTtDny_Jj8Ras319Xi6d1oBgRLGCpoH4BUDlkgvGY0DzlPBNS6lyD5EwwGSstOI1gTiKu09DPONMq4wyEDifoYchtrNl32rVJVbi-oqy1b5sQAYxCROPIo_d_0J3pbO3beYoIGvo_iKceB0pZ45zVedLYwhs6JASS3n7i7Se_9j17d0zs0srfnsiTbg_MBuC7KPXh_6Tkbfk8RP4ATaSOBA</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Molony, Peter</creator><creator>Kharytaniuk, Natallia</creator><creator>Boyle, Seamus</creator><creator>Woods, Robbie S. R.</creator><creator>O'Leary, Gerard</creator><creator>Werner, Reiltin</creator><creator>Heffron, Cynthia</creator><creator>Feeley, Linda</creator><creator>Sheahan, Patrick</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9153-8951</orcidid></search><sort><creationdate>201708</creationdate><title>Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status</title><author>Molony, Peter ; Kharytaniuk, Natallia ; Boyle, Seamus ; Woods, Robbie S. R. ; O'Leary, Gerard ; Werner, Reiltin ; Heffron, Cynthia ; Feeley, Linda ; Sheahan, Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4194-4b920970cf0d947812fb77d9aaefe0a7494a8ce972605167eb30518decd7409e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Carcinoma, Squamous Cell - virology</topic><topic>Chemoradiotherapy</topic><topic>Dysplasia</topic><topic>Head & neck cancer</topic><topic>Human papillomavirus</topic><topic>Human papillomavirus 16 - isolation & purification</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>margins</topic><topic>Margins of Excision</topic><topic>Middle Aged</topic><topic>Neck</topic><topic>Neoplasm Recurrence, Local</topic><topic>Oropharyngeal Neoplasms - mortality</topic><topic>Oropharyngeal Neoplasms - surgery</topic><topic>Oropharyngeal Neoplasms - virology</topic><topic>oropharynx</topic><topic>p16</topic><topic>Papillomavirus Infections - complications</topic><topic>Plastic surgery</topic><topic>Radiation therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Squamous cell carcinoma</topic><topic>Throat cancer</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Molony, Peter</creatorcontrib><creatorcontrib>Kharytaniuk, Natallia</creatorcontrib><creatorcontrib>Boyle, Seamus</creatorcontrib><creatorcontrib>Woods, Robbie S. R.</creatorcontrib><creatorcontrib>O'Leary, Gerard</creatorcontrib><creatorcontrib>Werner, Reiltin</creatorcontrib><creatorcontrib>Heffron, Cynthia</creatorcontrib><creatorcontrib>Feeley, Linda</creatorcontrib><creatorcontrib>Sheahan, Patrick</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Head & neck</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Molony, Peter</au><au>Kharytaniuk, Natallia</au><au>Boyle, Seamus</au><au>Woods, Robbie S. R.</au><au>O'Leary, Gerard</au><au>Werner, Reiltin</au><au>Heffron, Cynthia</au><au>Feeley, Linda</au><au>Sheahan, Patrick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status</atitle><jtitle>Head & neck</jtitle><addtitle>Head Neck</addtitle><date>2017-08</date><risdate>2017</risdate><volume>39</volume><issue>8</issue><spage>1680</spage><epage>1688</epage><pages>1680-1688</pages><issn>1043-3074</issn><eissn>1097-0347</eissn><abstract>Background
Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).
Methods
We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease‐specific survival (DSS) was studied according to p16 status.
Results
Twenty‐one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16‐negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16‐positive disease, margin status had no impact on DSS.
Conclusion
Patients with p16‐positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28560813</pmid><doi>10.1002/hed.24824</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9153-8951</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - surgery Carcinoma, Squamous Cell - virology Chemoradiotherapy Dysplasia Head & neck cancer Human papillomavirus Human papillomavirus 16 - isolation & purification Humans Kaplan-Meier Estimate Male margins Margins of Excision Middle Aged Neck Neoplasm Recurrence, Local Oropharyngeal Neoplasms - mortality Oropharyngeal Neoplasms - surgery Oropharyngeal Neoplasms - virology oropharynx p16 Papillomavirus Infections - complications Plastic surgery Radiation therapy Retrospective Studies Risk Factors Squamous cell carcinoma Throat cancer Treatment Outcome |
| title | Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status |
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