HIV+ patients with HNC have inferior oncologic and functional outcomes compared to HIV− patients. HPV positivity and smoking did not have a statistically significant impact on clinical outcomes. Innovative treatment modalities and approaches with better efficacy and less morbidity need to be developed for this growing patient population.
Waleed F. Mourad, Kenneth S. Hu, Catherine Concert, Daniel Shasha, Louis B. Harrison; Beth Israel Medical Center
OBJECTIVES: To report the clinical outcomes and the impact of HPV, HIV, and smoking on patients with head and neck cancer (HNC).
MATERIALS AND METHODS: This is a single-institution retrospective study of 105 HIV+ pts with HNC treated from 1998–2013. The median age at radiation therapy (RT) and HIV diagnosis was 51 years (range: 32–72 yr) and 34 (range: 25–50 yr), respectively. HIV duration was 11 years (range: 6–20 yr). A total of 22%, 27%, and 51% had stage I-II, III, and IV disease, respectively. A total of 37% were treated with RT alone, while 63% received concurrent chemoradiation (CRT), and 50% of patients were on highly active antiretroviral therapy (HAART) during treatment. A total of 34 patients had oropharyngeal squamous cell carcinoma (SCC) and metastases of unknown primary origin, 50% of whom were HPV+. Median doses of 70, 63, and 54 Gy were delivered at 1.8–2-Gy/fraction to gross disease and high- and low-risk neck, respectively. Twelve patients underwent neck dissection for N3 disease.
RESULTS: Acute skin desquamation and mucositis grade ≤ 2 and 3 rates were 70% and 30%, respectively. Rates of treatment breaks ≥ 10 and 5 days were 10% and 20%, respectively. One patient died from induction chemotherapy (CT), 1 died several weeks post transoral robotic surgery (TORS) for T2N1 SCC of the tonsil, 1 developed grade 4 mucositis, and 1 developed osteoradionecrosis during CRT. The median weight loss was 25 lbs (range: 6–40lbs). With a median follow-up of 60 months (range: 12–140 mo), rates of late dysphagia grades ≤ 2, 3, and 4 were 74%, 15%, and 11%, respectively. Rates of late xerostomia grades ≤ 2 and 3 were 77% and 23%, respectively. The median CD4 counts and viral loads before, during, and after treatment were 370, 135, and 100 and 0, 160, and 260 cells/Î¼L, respectively. Seven patients developed second primary malignancy. The 4-year locoregional control (LRC) and overall survival (OS) rates were 65% and 50%, respectively. Chi-square test showed a significant relationship between LRC and both RT duration and CT, as well as a relationship between lower CD4 counts and higher viral load) (P = .001). Positive trends were observed between weight loss ≤ 10% and LRC and between absence of second malignancy and OS. There was no significant relationship between HPV positivity, smoking, or CT with either LRC or OS.
CONCLUSIONS: HIV+ patients with HNC have inferior oncologic and functional outcomes compared to HIV− patients. HPV positivity and smoking did not have a statistically significant impact on clinical outcomes. Innovative treatment modalities and approaches with better efficacy and less morbidity need to be developed for this growing patient population.
Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org