(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status

Publication
Article
OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

Increasing time from diagnosis to simulation and from simulation until the start of therapy is associated with worse outcomes. Patients with HPV-associated oropharyngeal squamous cell carcinoma are at increased risk of nodal progression before treatment.

Mark Jeffry Amsbaugh, MD, Mehran Yusuf, BA, Elizabeth Cash, PhD, Craig Silverman, MD, Neal Dunlap, MD; University of Louisville

PURPOSE: To determine the effect of treatment delays for patients receiving radiation therapy for oropharyngeal squamous cell carcinoma (OPSCC).

MATERIALS AND METHODS: We examined patients seen in our multidisciplinary clinic from 2009 to 2014 with a diagnosis of OPSCC from a prospective database. Nodal tumor volumes were compared with staging imaging to identify nodal progression (higher N stage or more involved cervical lymph node levels). Chi-square, logistic, and Cox proportional hazards models were used to identify predictive factors and generate survival estimates. Spearman correlations and receiver operating characteristic (ROC) curves were used to characterize relationships between delays and outcomes.

RESULTS: Median elapsed times from staging to simulation, simulation to treatment start, and treatment start to treatment completion were 35, 10, and 44 days, respectively, for 156 patients. Sixty-eight patients (43.6%) exhibited nodal progression at the time of simulation. Patients with human papilloma virus (HPV)-associated OPSCC were more likely to have nodal progression (odds ratio [OR], 2.818 [95% CI, 1.292–6.146]), with increased odds seen among patients with intermediate-risk disease (OR, 3.194 [95% CI, 1.372–7.436]). Increasing time from staging to simulation was associated with nodal progression (P < .001), which placed patients at greater risk for distant failure (hazard ratio [HR], 3.682 [95% CI, 1.311–10.337]). An optimal cut point of 32 days from staging to simulation was established, with a sensitivity of 77.9% and a specificity of 60.2% for nodal progression. As time from simulation to the start of treatment increased, patients with nodal progression at simulation had greater risk of distant failure (HR, 3.958 [95% CI, 1.406–11.141]) and poorer progression-free survival (HR, 1.786 [95% CI, 1.008–3.165]).

CONCLUSIONS: Increasing time from diagnosis to simulation and from simulation until the start of therapy is associated with worse outcomes. Patients with HPV-associated OPSCC-specifically with intermediate-risk disease-are at increased risk of nodal progression before treatment. 

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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