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p16 status and interval neck dissection findings after a ‘clinically complete response’ to chemoradiotherapy in oropharyngeal squamous cell carcinoma

Published online by Cambridge University Press:  19 June 2015

M S Miah*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
P Spielmann
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
S J White
Affiliation:
Department of Pathology, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
C Kennedy
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
N Kernohan
Affiliation:
Department of Pathology, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
R E Mountain
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
R Cassasola
Affiliation:
Tayside Cancer Centre, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
S Mahendran
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Scotland, UK
*
Address for correspondence: Mr Mohammed S Miah, Department of Otorhinolaryngology – Head and Neck Surgery, Ninewells Hospital and University of Dundee Medical School, Dundee DD1 9SY, Scotland, UK Fax: (+44) 01382 632816 E-mail: [email protected]

Abstract

Objectives:

To evaluate the histopathological findings from post-treatment neck dissection of p16 positive and negative oropharyngeal carcinoma cases, after completion of chemoradiotherapy, and to question the role of neck dissection after a ‘clinically complete response’ to chemoradiotherapy.

Methods:

Data were collected retrospectively from a cohort of patients treated with curative intent using chemoradiotherapy and post-treatment neck dissection. Primary tumours underwent p16 immunohistochemistry. Neck dissection specimens were examined for viable cancer cells.

Results:

A total of 76 cases were assessed. Viable cancer cells were detected from neck dissection in 29 per cent of p16 negative cases. Locoregional recurrence occurred in 12.9 per cent of p16 negative cases. The association between p16 positivity in the primary tumour and histopathologically negative neck dissection was significant (p < 0.05).

Conclusion:

p16 status appeared to be an independent marker of disease control for the cohort in this study. The data raise questions about the role of post-treatment neck dissection in p16 positive cases with a ‘clinically complete response’ to chemoradiotherapy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented orally at the Scottish Otorhinolaryngological Society summer meeting, 9–10 May 2013, Dunblane, Scotland, UK.

References

1Mehanna, H, Beech, T, Nicholson, T, El-Hariry, I, McConkey, C, Paleri, V et al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region. Head Neck 2013;35:747–55CrossRefGoogle ScholarPubMed
2Romanitan, M, Näsman, A, Ramqvist, T, Dahlstrand, H, Polykretis, L, Vogiatzis, P et al. Human papillomavirus frequency in oral and oropharyngeal cancer in Greece. Anticancer Res 2008;28:2077–80Google ScholarPubMed
3Hammarstedt, L, Lindquist, D, Dahlstrand, H, Romanitan, M, Dahlgren, L, Joneberg, J et al. Human papillomavirus as a risk factor for the increase in incidence of tonsillar cancer. Int J Cancer 2006;119:2620–3CrossRefGoogle ScholarPubMed
4Chaturvedi, AK, Engels, EA, Anderson, WF, Gillison, ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 2008;26:612–19CrossRefGoogle ScholarPubMed
5Castro, TP, Bussoloti Filho, I. Prevalence of human papillomavirus (HPV) in oral cavity and oropharynx. Braz J Otorhinolaryngol 2006;72:272–82CrossRefGoogle ScholarPubMed
6Hobbs, C, Sterne, J, Bailey, M, Heyderman, R, Birchall, M, Thomas, S. Human papillomavirus and head and neck cancer: a systematic review and meta-analysis. Clin Otolaryngol 2006;31:259–66CrossRefGoogle ScholarPubMed
7El-Mofty, S, Patil, S. Human papillomavirus (HPV)-related oropharyngeal nonkeratinizing squamous cell carcinoma: characterization of a distinct phenotype. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:339–45CrossRefGoogle ScholarPubMed
8Ang, KK, Harris, J, Wheeler, R, Weber, R, Rosenthal, D, Nguyen-Tân, P et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:2435CrossRefGoogle ScholarPubMed
9Termine, N, Panzarella, V, Falaschini, S, Russo, A, Matranga, D, Lo Muzio, L et al. HPV in oral squamous cell carcinoma vs head and neck squamous cell carcinoma biopsies: a meta-analysis (1988–2007). Ann Oncol 2008;19:1681–90CrossRefGoogle ScholarPubMed
10Scottish Intercollegiate Guidelines Network. Diagnosis and Management of Head and Neck Cancer: A National Clinical Guideline. Edinburgh: SIGN, 2006Google Scholar
11Evans, MF, Matthews, A, Kandil, D, Adamson, CS, Trotman, WE, Cooper, K. Discrimination of ‘driver’ and ‘passenger’ HPV in tonsillar carcinomas by the polymerase chain reaction, chromogenic in situ hybridization, and p16(INK4a) immunohistochemistry. Head Neck Pathol 2011;5:344–8CrossRefGoogle ScholarPubMed
12Lewis, JJ. p16 immunohistochemistry as a standalone test for risk stratification in oropharyngeal squamous cell carcinoma. Head Neck Pathol 2012;6:S7582CrossRefGoogle ScholarPubMed
13Kim, TW, Choi, SY, Ko, YH, Baek, C-H, Son, Y-I. The prognostic role of p16 expression in tonsil cancer treated by either surgery or radiation. Clin Exp Otorhinolaryngol 2012;5:207–12CrossRefGoogle ScholarPubMed
14El-Naggar, AK, Westra, WH. p16 expression as a surrogate marker for HPV-related oropharyngeal carcinoma: a guide for interpretative relevance and consistency. Head Neck 2012;34:459–61CrossRefGoogle ScholarPubMed
15Smeets, S, Hesselink, A, Speel, E, Haesevoets, A, Snijders, P, Pawlita, M et al. A novel algorithm for reliable detection of human papillomavirus in paraffin embedded head and neck cancer specimen. Int J Cancer 2007;121:2465–72CrossRefGoogle ScholarPubMed
16Schache, A, Liloglou, T, Risk, J, Filia, A, Jones, T, Sheard, J et al. Evaluation of human papilloma virus diagnostic testing in oropharyngeal squamous cell carcinoma: sensitivity, specificity, and prognostic discrimination. Clin Cancer Res 2011;17:6262–71CrossRefGoogle ScholarPubMed
17Fischer, C, Kampmann, M, Zlobec, I, Green, E, Tornillo, L, Lugli, A et al. p16 expression in oropharyngeal cancer: its impact on staging and prognosis compared with the conventional clinical staging parameters. Ann Oncol 2010;21:1961–6CrossRefGoogle ScholarPubMed
18Singhi, A, Westra, W. Comparison of human papillomavirus in situ hybridization and p16 immunohistochemistry in the detection of human papillomavirus-associated head and neck cancer based on a prospective clinical experience. Cancer 2010;116:2166–73CrossRefGoogle ScholarPubMed
19Tan, M, Fakhry, C, Fan, K, Zaboli, D, Neuner, G, Zinreich, ES et al. . Timing of restaging PET/CT and neck dissection after chemoradiation for advanced head and neck squamous cell carcinoma. Otolaryngology 3:128Google Scholar
20Shoushtari, A, Meeneghan, M, Sheng, K, Moskaluk, CA, Thomas, CY, Reibel, JF et al. Intensity-modulated radiotherapy outcomes for oropharyngeal squamous cell carcinoma patients stratified by p16 status. Cancer 2010;116:2645–54CrossRefGoogle ScholarPubMed
21Pellini, R, Mercante, G, Marchese, C, Terenzi, V, Sperduti, I, Manciocco, V et al. Predictive factors for postoperative wound complications after neck dissection. Acta Otorhinolaryngol Ital 2013;33:1622Google ScholarPubMed
22Newman, JP, Terris, DJ, Pinto, HA, Fee, WE Jr, Goode, RL, Goffinet, DR. Surgical morbidity of neck dissection after chemoradiotherapy in advanced head and neck cancer. Ann Otol Rhinol Laryngol 1997;106:117–22CrossRefGoogle ScholarPubMed
23Hillel, AT, Fakhry, C, Pai, SI, Williams, MF, Blanco, RG, Zinreich, ES et al. Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma. Otolaryngol Head Neck Surg 2009;141:737–42CrossRefGoogle ScholarPubMed
24Kim, M, Kim, YS, Han, EJ, Yoo, LR, Song, J-H, Lee, S-N et al. FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer. Radiat Oncol J 2011;29:243–51CrossRefGoogle ScholarPubMed
25Agarwal, V, Branstetter, BF, Johnson, JT. Indications for PET/CT in the head and neck. Otolaryngol Clin North Am 2008;41:2349CrossRefGoogle ScholarPubMed
26Zang, I, Branstetter, BF, Beswick, DM, Maxwell, DH, Gooding, WE, Ferris, RL. The benefit of early PET/CT surveillance in HPV-associated head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2011;137:1106–11CrossRefGoogle Scholar
27Beswick, DM, Gooding, WE, Johnson, JT, Branstetter, BF. Temporal patterns of head and neck squamous cell carcinoma recurrence with positron-emission tomography/computed tomography monitoring. Laryngoscope 2012;122:1512–17CrossRefGoogle ScholarPubMed
28Kim, SY, Kim, JS, Yi, JS, Lee, JH, Choi, SH, Nam, SY et al. Evaluation of 18 F-FDG PET/CT and CT/MRI with histopathologic correlation in patients undergoing salvage surgery for head and neck squamous cell carcinoma. Ann Surg Oncol 2011;18:2579–84CrossRefGoogle ScholarPubMed
29Pryor, DI, Porceddu, SV, Scuffham, PA, Whitty, JA, Thomas, PA, Burmeister, BH. Economic analysis of FDG-PET-guided management of the neck after primary chemoradiotherapy for node-positive head and neck squamous cell carcinoma. Head Neck 2013;35:1287–94CrossRefGoogle ScholarPubMed