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Oropharyngeal Cancer in Young Adults: An Alarming National Trend
S436
International Journal of Radiation Oncology Biology Physics
successful salvage with further chemoradiation as this recurrence was outside of the previous RT field. The other patient recurred in the neck was not salvaged by further chemotherapy and died of disease progression. Two patients failed with non-traditional patterns of metastatic spread for SCC of the head and neck. Both patients had stage IVa, HPV-16, tonsil primaries, and both a complete response to an unremarkable course of concurrent chemoradiation in the head and neck at follow-up. For both patients, PET/CT at 60-90 days post-chemoradiation showed diffuse, widespread osseous and soft tissue metastasis. Conclusions: HPV infection of SCC of the head and neck is suggested to be associated with improved outcomes following definitive therapy. While our experiences support this, some HPV positive cases follow an atypical clinical course. Further investigation is necessary into these cases. Author Disclosure: C.L. Matthiesen: None. R.B. Maymani: None. A. Arain: None. S. Ahmad: None. E. Syzek: None. T. Herman: None. C. Bogardus: None.
Author Disclosure: F. Siddiqui: None. T. Ghanem: None. F. Hall: None. M. Cote: None. J. Ruterbusch: None. M. Elshaikh: None.
2609 Oropharyngeal Cancer in Young Adults: An Alarming National Trend F. Siddiqui,1 T. Ghanem,1 F. Hall,1 M. Cote,2 J. Ruterbusch,2 and M. Elshaikh1; 1Henry Ford Health System, Detroit, MI, 2Wayne State University Karmanos Cancer Institute, Detroit, MI Purpose/Objective(s): Oropharyngeal cancers (OpxCa) have been increasing in incidence in recent years due to increasing rates of HPV infection. This increase has largely been attributed to changes in sexual practices in the 1960-70s. There remains paucity of data regarding incidence, trends and treatment outcomes in patients younger than 45 years. The purpose of this study is to investigate these factors among younger patients with OpxCa born in this time period. Materials/Methods: We queried the SEER 9 database for the years 19732009 for patients <45 years of age with invasive squamous cell carcinoma (SCC) of the oropharyngeal subsites. SEER database does not record HPV information. Hence, tumor grade (III/IV) was used as a surrogate indicator of HPV positivity. Results: There were 1603 patients with OpxCa. Most cases were in the 3644 yr group (90%) and the majority were white (73%). A significant (p < 0.05) increase in age-adjusted is noted from 0.23 per 100,000 in 1979 to 0.37 per 100,000 in 2009. A major difference in trends is seen based on race. There has been a steady in incidence among whites with a 113% increase between 1973 and 2009. Surprisingly, in the same time period the incidence rates in blacks have declined ( 52.5%). The proportion of grade III/IV SCC has also steadily increased from 28% in 1973-79 to 43% in 2000-2009 (p < 0.0001). SEER summary stages have also shown a changing trend with decreasing local and metastatic stages while “regional” stage has increased from 49% in 1973-79 to 72% in recent years (p Z 0.02). The majority (50-65% in different time periods) of these young adults have undergone surgical resection for their tumors. Five-year survival for the study cohort is 54%. There was no difference in survival based on gender. Blacks tended to have significantly inferior survival compared to other races (p < 0.0001). Patients undergoing both surgery and RT had the highest 5-yr survival followed by surgery alone (early stage patients) and radiation alone (p < 0.0001). A total of 200 second primary cancers was noted in these 1603 patients of which most were in the oral cavity and pharynx (n Z 69), lung and bronchus (n Z 44) and esophagus (n Z 18). Conclusions: This SEER analysis shows a continued rise in OpxCa in the <45 year old US population which is likely HPV-related (grade III/IV). This increase is primarily seen among whites while decreasing trend is seen among blacks. Its predominance in this age group suggests either nonsexual modes of HPV transfer at a younger age or a shortened latency period between infection and development of OpxCa. These patients have a favorable prognosis and are likely to live longer while dealing with treatment related side-effects negatively impacting their quality of life. This group of younger patients should be carefully studied for prevention and treatment strategies including possible de-escalation of therapy in HPV-positive patients.
2610 Utility of Post-Chemoradiation Therapy FDG-PET/CT Response for Prediction of Locoregional Control in HPV-Related Oropharyngeal Cancer J.M. Vainshtein, M. Spector, M. Stenmark, T.E. Carey, D. Chepeha, K. Wong, and A. Eisbruch; University of Michigan, Ann Arbor, MI Purpose/Objective(s): Data on the utility of FDG-PET/CT for postchemoradiation therapy (CRT) response assessment in HPV+ oropharyngeal cancer (OPC) remains limited. We sought to assess the ability of 3-month PET/CT response to predict locoregional failure (LRF) in a uniformly treated cohort of locally advanced HPV+ OPC patients. Materials/Methods: One hundred one consecutive patients with stage III/ IV HPV+ OPC who completed definitive CRT with concomitant carboplatin/paclitaxel at our institution between 2005 and 2010, and who underwent pre-treatment and 3-month post-therapy FDG-PET/CT, were retrospectively identified. PET/CT response for each the primary site and neck was scored as either complete (CR) or partial (PR). CT response in the neck at 3 months was graded per RECIST 1.1. The accuracy of 3month PET/CT response to predict 3-year local failure (LF) and regional failure (RF) (including residual viable tumor cells at planned neck dissection) was evaluated. Results: Median follow-up was 42 months. Among 98 patients with an evaluable primary, LF occurred in 2/87 (2%) patients with CR and 1/11 (9%) with PR on 3-month PET/CT; thus, PET/CT response was 88% accurate, 33% sensitive, and 90% specific for LF, with 9% positive predictive value (PPV) and 98% negative predictive value (NPV). Among 91 patients with measurable neck nodes by RECIST, RF occurred in 6/67 (9%) with CR and 2/18 (11%) with PR. For prediction of RF, 3-month PET/CT response had 76% accuracy, 25% sensitivity, 81% specificity, 11% PPV, and 91.8% NPV. CT response for the neck performed even worse than PET/CT for prediction of RF (accuracy 56% vs 75%, respectively). Quantitative thresholds or % change in SUVmax assessment did not improve the predictive accuracy of 3-month PET/CT for LRF. Sixty-seven of 101 patients underwent a total of 127 additional surveillance PET/CT scans, with a median 2 scans per patient (range, 1-4) beginning at a median 4.1 months (interquartile range, 3.2-8.3) after the initial post-CRT scan. PET/CT surveillance detected 6/8 LRFs (1/2 LFs and 5/6 RFs) in the absence of other clinical evidence of recurrence, and overall was 95% accurate for both LF and RF. Conclusions: In this uniformly treated cohort, representing the largest study to-date of PET/CT response assessment in HPV+ OPC, the response at 3 months demonstrated high NPV for LRF, related to the low incidence of LRF in this favorable prognosis population. PET/CT response also demonstrated poor sensitivity and PPV for predicting LRF. In contrast, PET/CT surveillance detected the majority of LRFs prior to clinical presentation, suggesting an important potential role for PET surveillance in these patients. Author Disclosure: J.M. Vainshtein: None. M. Spector: None. M. Stenmark: None. T.E. Carey: None. D. Chepeha: None. K. Wong: None. A. Eisbruch: None.
2611 Molecular Markers and Imaging: Prognostic Implications for HPV-Related Oropharyngeal Cancer J.M. Vainshtein, M. Spector, S. Byrd, M. Stenmark, K. Wong, F. Worden, T.E. Carey, D. Chepeha, and A. Eisbruch; University of Michigan, Ann Arbor, MI Purpose/Objective(s): HPV+ oropharyngeal cancer (OPC) patients without heavy smoking or advanced stage have been proposed as candidates for radiation dose de-escalation. We hypothesized that molecular imaging and molecular markers could help predict locoregional failure
International Journal of Radiation Oncology Biology Physics
successful salvage with further chemoradiation as this recurrence was outside of the previous RT field. The other patient recurred in the neck was not salvaged by further chemotherapy and died of disease progression. Two patients failed with non-traditional patterns of metastatic spread for SCC of the head and neck. Both patients had stage IVa, HPV-16, tonsil primaries, and both a complete response to an unremarkable course of concurrent chemoradiation in the head and neck at follow-up. For both patients, PET/CT at 60-90 days post-chemoradiation showed diffuse, widespread osseous and soft tissue metastasis. Conclusions: HPV infection of SCC of the head and neck is suggested to be associated with improved outcomes following definitive therapy. While our experiences support this, some HPV positive cases follow an atypical clinical course. Further investigation is necessary into these cases. Author Disclosure: C.L. Matthiesen: None. R.B. Maymani: None. A. Arain: None. S. Ahmad: None. E. Syzek: None. T. Herman: None. C. Bogardus: None.
Author Disclosure: F. Siddiqui: None. T. Ghanem: None. F. Hall: None. M. Cote: None. J. Ruterbusch: None. M. Elshaikh: None.
2609 Oropharyngeal Cancer in Young Adults: An Alarming National Trend F. Siddiqui,1 T. Ghanem,1 F. Hall,1 M. Cote,2 J. Ruterbusch,2 and M. Elshaikh1; 1Henry Ford Health System, Detroit, MI, 2Wayne State University Karmanos Cancer Institute, Detroit, MI Purpose/Objective(s): Oropharyngeal cancers (OpxCa) have been increasing in incidence in recent years due to increasing rates of HPV infection. This increase has largely been attributed to changes in sexual practices in the 1960-70s. There remains paucity of data regarding incidence, trends and treatment outcomes in patients younger than 45 years. The purpose of this study is to investigate these factors among younger patients with OpxCa born in this time period. Materials/Methods: We queried the SEER 9 database for the years 19732009 for patients <45 years of age with invasive squamous cell carcinoma (SCC) of the oropharyngeal subsites. SEER database does not record HPV information. Hence, tumor grade (III/IV) was used as a surrogate indicator of HPV positivity. Results: There were 1603 patients with OpxCa. Most cases were in the 3644 yr group (90%) and the majority were white (73%). A significant (p < 0.05) increase in age-adjusted is noted from 0.23 per 100,000 in 1979 to 0.37 per 100,000 in 2009. A major difference in trends is seen based on race. There has been a steady in incidence among whites with a 113% increase between 1973 and 2009. Surprisingly, in the same time period the incidence rates in blacks have declined ( 52.5%). The proportion of grade III/IV SCC has also steadily increased from 28% in 1973-79 to 43% in 2000-2009 (p < 0.0001). SEER summary stages have also shown a changing trend with decreasing local and metastatic stages while “regional” stage has increased from 49% in 1973-79 to 72% in recent years (p Z 0.02). The majority (50-65% in different time periods) of these young adults have undergone surgical resection for their tumors. Five-year survival for the study cohort is 54%. There was no difference in survival based on gender. Blacks tended to have significantly inferior survival compared to other races (p < 0.0001). Patients undergoing both surgery and RT had the highest 5-yr survival followed by surgery alone (early stage patients) and radiation alone (p < 0.0001). A total of 200 second primary cancers was noted in these 1603 patients of which most were in the oral cavity and pharynx (n Z 69), lung and bronchus (n Z 44) and esophagus (n Z 18). Conclusions: This SEER analysis shows a continued rise in OpxCa in the <45 year old US population which is likely HPV-related (grade III/IV). This increase is primarily seen among whites while decreasing trend is seen among blacks. Its predominance in this age group suggests either nonsexual modes of HPV transfer at a younger age or a shortened latency period between infection and development of OpxCa. These patients have a favorable prognosis and are likely to live longer while dealing with treatment related side-effects negatively impacting their quality of life. This group of younger patients should be carefully studied for prevention and treatment strategies including possible de-escalation of therapy in HPV-positive patients.
2610 Utility of Post-Chemoradiation Therapy FDG-PET/CT Response for Prediction of Locoregional Control in HPV-Related Oropharyngeal Cancer J.M. Vainshtein, M. Spector, M. Stenmark, T.E. Carey, D. Chepeha, K. Wong, and A. Eisbruch; University of Michigan, Ann Arbor, MI Purpose/Objective(s): Data on the utility of FDG-PET/CT for postchemoradiation therapy (CRT) response assessment in HPV+ oropharyngeal cancer (OPC) remains limited. We sought to assess the ability of 3-month PET/CT response to predict locoregional failure (LRF) in a uniformly treated cohort of locally advanced HPV+ OPC patients. Materials/Methods: One hundred one consecutive patients with stage III/ IV HPV+ OPC who completed definitive CRT with concomitant carboplatin/paclitaxel at our institution between 2005 and 2010, and who underwent pre-treatment and 3-month post-therapy FDG-PET/CT, were retrospectively identified. PET/CT response for each the primary site and neck was scored as either complete (CR) or partial (PR). CT response in the neck at 3 months was graded per RECIST 1.1. The accuracy of 3month PET/CT response to predict 3-year local failure (LF) and regional failure (RF) (including residual viable tumor cells at planned neck dissection) was evaluated. Results: Median follow-up was 42 months. Among 98 patients with an evaluable primary, LF occurred in 2/87 (2%) patients with CR and 1/11 (9%) with PR on 3-month PET/CT; thus, PET/CT response was 88% accurate, 33% sensitive, and 90% specific for LF, with 9% positive predictive value (PPV) and 98% negative predictive value (NPV). Among 91 patients with measurable neck nodes by RECIST, RF occurred in 6/67 (9%) with CR and 2/18 (11%) with PR. For prediction of RF, 3-month PET/CT response had 76% accuracy, 25% sensitivity, 81% specificity, 11% PPV, and 91.8% NPV. CT response for the neck performed even worse than PET/CT for prediction of RF (accuracy 56% vs 75%, respectively). Quantitative thresholds or % change in SUVmax assessment did not improve the predictive accuracy of 3-month PET/CT for LRF. Sixty-seven of 101 patients underwent a total of 127 additional surveillance PET/CT scans, with a median 2 scans per patient (range, 1-4) beginning at a median 4.1 months (interquartile range, 3.2-8.3) after the initial post-CRT scan. PET/CT surveillance detected 6/8 LRFs (1/2 LFs and 5/6 RFs) in the absence of other clinical evidence of recurrence, and overall was 95% accurate for both LF and RF. Conclusions: In this uniformly treated cohort, representing the largest study to-date of PET/CT response assessment in HPV+ OPC, the response at 3 months demonstrated high NPV for LRF, related to the low incidence of LRF in this favorable prognosis population. PET/CT response also demonstrated poor sensitivity and PPV for predicting LRF. In contrast, PET/CT surveillance detected the majority of LRFs prior to clinical presentation, suggesting an important potential role for PET surveillance in these patients. Author Disclosure: J.M. Vainshtein: None. M. Spector: None. M. Stenmark: None. T.E. Carey: None. D. Chepeha: None. K. Wong: None. A. Eisbruch: None.
2611 Molecular Markers and Imaging: Prognostic Implications for HPV-Related Oropharyngeal Cancer J.M. Vainshtein, M. Spector, S. Byrd, M. Stenmark, K. Wong, F. Worden, T.E. Carey, D. Chepeha, and A. Eisbruch; University of Michigan, Ann Arbor, MI Purpose/Objective(s): HPV+ oropharyngeal cancer (OPC) patients without heavy smoking or advanced stage have been proposed as candidates for radiation dose de-escalation. We hypothesized that molecular imaging and molecular markers could help predict locoregional failure