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Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial.

Publication ,  Journal Article
Wang, K; Wong, TZ; Amdur, RJ; Mendenhall, WM; Sheets, NC; Green, R; Thorp, BD; Patel, SN; Hackman, TG; Zanation, AM; Weissler, MC; Chera, BS
Published in: Oral Oncol
March 2018

OBJECTIVES: We evaluated patterns of nodal response and positive predictive value (PPV) of 3 month post-treatment PET in patients with HPV-associated oropharyngeal cancer treated on a multi-institutional de-intensification trial. MATERIALS AND METHODS: Eligibility criteria included: (1) T0-3, N0-2c, M0, (2) HPV+/p16+ oropharyngeal squamous cell carcinoma, and (3) ≤10 pack-years smoking or ≤30 pack-years and abstinent ≥5 years. Patients received 60 Gy radiation alone (T0-2, N0-1) or with concurrent weekly cisplatin 30 mg/m2 and surveillance PET three months post-radiation. Nodal responses were categorized as complete (CR), equivocal (ER), or incomplete (IR) using both local and central radiographic review. A "true positive" was ER/IR with clinical/radiographic progression or positive pathology. RESULTS: 79 node-positive pts (84% N2) were analyzed. Distribution of nodal CR, ER, and IR was 44 (56%), 27 (34%), and 8 (10%), respectively. 29 (37%) had ER/IR in pre-treatment node-positive neck levels, whereas 14 (18%) had ER/IR in pre-treatment node-negative levels. Of patients with ER/IR, 5 were observed clinically, 19 received repeat imaging, and 11 received either biopsy (1) or neck dissection (10). The PPV was 9% for ER/IR and 13% for IR, with 3 patients found to have persistent disease on neck dissection. There was no difference in nodal relapse rate in patients with nodal CR vs. nodal ER/IR. CONCLUSION: Post-treatment PET may not accurately predict the presence of persistent disease in patients with favorable-risk oropharynx cancer. These results support close surveillance rather than surgical evaluation in most favorable-risk patients.

Duke Scholars

Published In

Oral Oncol

DOI

EISSN

1879-0593

Publication Date

March 2018

Volume

78

Start / End Page

108 / 113

Location

England

Related Subject Headings

  • Positron-Emission Tomography
  • Oropharyngeal Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Kaplan-Meier Estimate
  • Humans
  • Female
  • Dentistry
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, K., Wong, T. Z., Amdur, R. J., Mendenhall, W. M., Sheets, N. C., Green, R., … Chera, B. S. (2018). Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial. Oral Oncol, 78, 108–113. https://doi.org/10.1016/j.oraloncology.2018.01.023
Wang, Kyle, Terence Z. Wong, Robert J. Amdur, William M. Mendenhall, Nathan C. Sheets, Rebecca Green, Brian D. Thorp, et al. “Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial.Oral Oncol 78 (March 2018): 108–13. https://doi.org/10.1016/j.oraloncology.2018.01.023.
Wang K, Wong TZ, Amdur RJ, Mendenhall WM, Sheets NC, Green R, et al. Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial. Oral Oncol. 2018 Mar;78:108–13.
Wang, Kyle, et al. “Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial.Oral Oncol, vol. 78, Mar. 2018, pp. 108–13. Pubmed, doi:10.1016/j.oraloncology.2018.01.023.
Wang K, Wong TZ, Amdur RJ, Mendenhall WM, Sheets NC, Green R, Thorp BD, Patel SN, Hackman TG, Zanation AM, Weissler MC, Chera BS. Pitfalls of post-treatment PET after de-intensified chemoradiotherapy for HPV-associated oropharynx cancer: Secondary analysis of a phase 2 trial. Oral Oncol. 2018 Mar;78:108–113.
Journal cover image

Published In

Oral Oncol

DOI

EISSN

1879-0593

Publication Date

March 2018

Volume

78

Start / End Page

108 / 113

Location

England

Related Subject Headings

  • Positron-Emission Tomography
  • Oropharyngeal Neoplasms
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lymphatic Metastasis
  • Kaplan-Meier Estimate
  • Humans
  • Female
  • Dentistry