Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study

Dorian Culié; Renaud Schiappa; Anouchka Modesto; Julien Viotti; Emmanuel Chamorey; Olivier Dassonville; Gilles Poissonnet; Alain Bizeau; Sebastien Vergez; Agnes Dupret-Bories; Nicolas Fakhry; Laure Santini; Benjamin Lallemant; Guillaume Chambon; Anne Sudaka; Frederic Peyrade; Esma Saada-Bouzid; Karen Benezery; Florence Jourdan-Soulier; Françoise Chapel; Anne Sophie Ramay; Pascal Roger; Thibault Galissier; Valérie Coste; Aicha Ben Lakdar; Joanne Guerlain; Haitham Mirghani; Phillipe Gorphe; Bruno Guelfucci; Renaud Garrel; Stephane Temam; Alexandre Bozec

doi:10.1016/j.ejso.2020.12.011

Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study

Eur J Surg Oncol. 2021 Jun;47(6):1389-1397. doi: 10.1016/j.ejso.2020.12.011. Epub 2021 Jan 1.

Authors

Dorian Culié¹, Renaud Schiappa², Anouchka Modesto³, Julien Viotti², Emmanuel Chamorey², Olivier Dassonville⁴, Gilles Poissonnet⁴, Alain Bizeau⁵, Sebastien Vergez⁶, Agnes Dupret-Bories⁶, Nicolas Fakhry⁷, Laure Santini⁷, Benjamin Lallemant⁸, Guillaume Chambon⁸, Anne Sudaka⁹, Frederic Peyrade¹⁰, Esma Saada-Bouzid¹⁰, Karen Benezery¹¹, Florence Jourdan-Soulier¹², Françoise Chapel¹², Anne Sophie Ramay¹³, Pascal Roger¹³, Thibault Galissier¹⁴, Valérie Coste¹⁵, Aicha Ben Lakdar¹⁶, Joanne Guerlain¹⁷, Haitham Mirghani¹⁸, Phillipe Gorphe¹⁷, Bruno Guelfucci⁵, Renaud Garrel¹⁹, Stephane Temam¹⁷, Alexandre Bozec⁴

Affiliations

¹ University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France. Electronic address: dorian.culie@nice.unicancer.fr.
² Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
³ Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France.
⁴ University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
⁵ Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France.
⁶ Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France.
⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France.
⁸ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France.
⁹ Department of Pathology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
¹⁰ Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
¹¹ Department of Radiotherapy, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
¹² Department of Pathology, Sainte Musse Hospital, Toulon, France.
¹³ Department of Pathology, University Hospital of Nîmes, Nîmes, France.
¹⁴ Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France.
¹⁵ Department of Pathology, University Hospital of Montpellier, Montpellier, France.
¹⁶ Department of Pathology, Gustave Roussy Institute, Villejuif, France.
¹⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France.
¹⁸ Department of Otorhinolaryngology and Head and Neck Surgery, European Hospital Georges Pompidou, Paris, France.
¹⁹ Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France.

PMID: 33390333
DOI: 10.1016/j.ejso.2020.12.011

Abstract

Background: The aim of this study was to assess the impact of the initial therapeutic strategy on oncologic outcomes in patients with HPV-positive OPSCC.

Methods: All p16-positive OPSCCs treated from 2009 to 2014 in 7 centers were retrospectively included and classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Univariate, multivariate propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS).

Results: 382 patients were included (surgical group: 144; non-surgical group: 238). Five-year OS, DSS and RFS were 89.2, 96.8 and 83.9% in the surgical group and 84.2, 87.1 and 70.4% in the non-surgical group, respectively. These differences were statistically significant for DSS and RFS after multivariate analysis, but only for RFS after propensity score matching analysis.

Conclusion: In p16+ OPSCC patients, upfront surgery results in higher RFS than definitive radiotherapy ± chemotherapy but does not impact OS.

Keywords: Cancer; Human papilloma virus; Oropharynx; Radiotherapy; Surgery; Survival.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Antineoplastic Agents, Immunological / therapeutic use
Cetuximab / therapeutic use
Chemoradiotherapy, Adjuvant
Cisplatin / therapeutic use
Cyclin-Dependent Kinase Inhibitor p16 / metabolism*
Female
Humans
Induction Chemotherapy
Male
Middle Aged
Neoplasm Recurrence, Local / surgery*
Neoplasm Staging
Oropharyngeal Neoplasms / metabolism
Oropharyngeal Neoplasms / pathology*
Oropharyngeal Neoplasms / therapy*
Oropharyngeal Neoplasms / virology
Papillomavirus Infections / complications
Papillomavirus Infections / metabolism
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate

Substances

Antineoplastic Agents, Immunological
CDKN2A protein, human
Cyclin-Dependent Kinase Inhibitor p16
Cetuximab
Cisplatin