Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy

Trufelli, Damila Cristina; Matos, Leandro Luongo de; Santana, Thaiana Aragão; Capelli, Fábio de Aquino; Kanda, Jossi Ledo; Giglio, Auro Del; Castro Junior, Gilberto de

doi:10.1016/j.bjorl.2015.07.009

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Brazilian Journal of Otorhinolaryngology

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ORIGINAL ARTICLES • Braz. j. otorhinolaryngol. 81 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.bjorl.2015.07.009 copy

Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy^☆ ☆ Please cite this article as: Trufelli DC, de Matos LL, Santana TA, Capelli FA, Kanda JL, Del Giglio A, et al. Complete pathologic response as a prognostic factor for squamous cell carcinoma of the oropharynx post-chemoradiotherapy. Braz J Otorhinolaryngol. 2015;81:498-504.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

Chemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck.

OBJECTIVE:

To determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO.

METHODS:

Data were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy.

RESULTS:

A total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%;p = 0.049).

CONCLUSION:

The presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.

Keywords:
Oropharynx; Carcinoma; Squamous cell; Combined chemotherapy; Neck dissection

Variable	Result
Gender
Male	15 (78.9%)
Female	4 (21.1%)

Age (years) ^a	55.8 ± 8.1

Primary site
Soft palate	1 (5.3%)
Tongue base	5 (26.3%)
Vallecula	3 (15.8%)
Palatine tonsil	8 (42.1%)
Lateral wall	2 (10.5%)

Habits
Smoking	17 (89.5%)
Alcoholism	15 (78.9%)
HPV-positive status (p16-positive)	1 (5.3%)

Pretreatmen t
Concomitant chemoradiotherapy	12 (63.2%)
Induction chemotherapy followed by concomitant chemoradiotherapy	7 (36.8%)

Initial clinical stage
T stage
T2	4 (21.1%)
T3	8 (42.1%)
T4	7 (36.8%)
N stage
N2a	7 (36.8%)
N2b	3 (15.8%)
N2c	2 (10.6%)
N3	7 (36.8%)
Complete clinical response	12 (63.2%)
Complete pathological response	10 (52.6%)

Progression
Locoregional	4 (21.1%)
Distant	4 (21.1%)

Variable	Complete pathological response
	No	Yes	p-value
Age (years: mean±standard deviation)	55.3 ± 9.0	56.4 ± 7.4	0.780^a

Gender			0.303^b
Male	6 (66.7%)	9 (90.0%)
Female	3 (33.3%)	1 (10.0%)

Primary site			0.543^c
Soft palate	1 (11.1%)	0 (0.0%)
Tongue base	1 (11.1%)	4 (40.0%)
Vallecula	2 (22.2%)	1 (10.0%)
Palatine tonsil	4 (44.4%)	4 (40.0%)
Lateral wall	1 (11.1%)	1 (10.0%)

Previous treatment			1.000^b
Concomitant chemoradiotherapy	6 (66.7%)	6 (60.0%)
Induction chemotherapy followed by concomitant chemoradiotherapy	3 (33.3%)	4 (40.0%)

Cervical irradiation dose			0.370^b
5000cGy	6 (66.7%)	4 (40.0%)
7000cGy	3 (33.3%)	6 (60.0%)

Primary neoplasia differentiation			0.289^c
Well differentiated	1 (11.1%)	0 (0.0%)
Moderately differentiated	7 (77.8%)	10 (100.0%)
Poorly differentiated	1 (11.1%)	0 (0.0%)

Initial clinical stage
T stage			0.326^c
T2	3 (33.3%)	1 (10.0%)
T3	4 (44.4%)	4 (40.0%)
T4	2 (22.2%)	5 (50.0%)
N stage			0.462^c
N2a	3 (33.3%)	4 (40.0%)
N2b	1 (11.1%)	2 (20.0%)
N2c	2 (22.2%)	0 (0.0%)
N3	3 (33.3%)	4 (40.0%)

Complete clinical response			0.650^b
No	4 (44.4%)	3 (30.0%)
Yes	5 (55.6%)	7 (70.0%)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:lmatos@amcham.com.br (L.L. de Matos).