(S008) The Impact of HPV, HIV, and Smoking on Oncologic and Functional Outcomes in Patients With Head and Neck Cancer

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

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/μL, 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

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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