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PO-118: Incidence and Prognosis of HPV Induced Oropharyngeal Cancer in a Cohort of Patients Treated with Chemoradiation
S50 3 All India Institute of Medical Sciences, Oto-RhinoLaryngology, New Delhi, India 4 All India Institute of Medical Sciences, Medical Oncology, New Delhi, India
Purpose/Objective: Head and neck cancers (HNCa) are the most common cancers among males and third most common cancers overall in India and 70-80% patients present in advanced stage. Of these around 50% are eligible for curative, 35% for palliative radiotherapy and 15% for only supportive care. Palliative care and cancer directed treatment in advanced (HNCa) is not adequately studied. We did this Prospective study to assess symptom burden and quality of life in advanced HNCa patients suitable for Palliative radiotherapy. Materials and Methods: 100 patients who were suitable for Palliative Radiotherapy as decided in HNCa clinic were asked to fill EORTC QLQ C15-PAL Questionnaire which consisted of Global Quality of life (QOL), Physical Functioning (PF), Emotional Functioning (EF), fatigue (FA), Nausea & vomiting (NV), Pain (PA), Dyspnea (DY), sleep (SL), appetite (AP) and constipation (CO) and additional questions pertaining to swallowing (SW), hoarseness (HO), cough (CG), weight loss (WL), use of pain killers (PK), taste (TA), bleeding from tumour (BL), hearing (HE), pain in neck lump (PALMP), opening mouth (OM) and oral secretions (OS) based on a modified EORTC-HN35 questionnaire. Scoring was done to derive a score on 0-100 scale according to EORTC scoring Manual. Median and Range were calculated for each item for the entire cohort. Results: Of the 100 patients, 17 were Female and 83 were Male. 42% of them were more than or 60 years of age. 31 had carcinoma of Oral cavity, 46 of oropharynx, 14 of larynx and 9 others. 47 patients had Karnofsky performance status (KPS) of more than equal to 70. 66 patients had T4, 21 had T3, 34 had N2 and 32 had N3 disease. 10% of the patients had comorbidities. Median pack years of tobacco smoked was 35. 90% of the patients were tobacco consumers and of which 10% were also alcoholic. 82% of patients had education of below class 12th. Median QOL was 50 (Range 0-83.33) and PF was 77.78 (0-100). Median Score for EF and FA was 50. Median score for PA, SL, AP was 66.67. Median value for SW, HO, WL, BL, PALMP, CO and OS was 33.33 (100-0). While TA, CG, NV, DY and HE had a median score of 0.00. Conclusions: Advanced HNCa has a significant burden of symptoms. They report roughly loosing half their QOL. Though they maintain their PF at a higher level but have almost halving of EF. The top four symptoms are pain, Insomnia, loss of appetite and fatigue. Difficulty in swallowing, problem with oral secretions, difficulty in opening mouth and constipation are significant symptoms in our cohort of patients. We suggest each cancer centre should explore the symptom burden in their cohort of patients for identification of population and stage specific symptoms. These results would help in giving patients better symptom directed therapies and improve their quality of life.
POSTER: HPV RELATED H&N CANCER PO-118 INCIDENCE AND PROGNOSIS OF HPV INDUCED OROPHARYNGEAL CANCER IN A COHORT OF PATIENTS TREATED WITH CHEMORADIATION L. Cerezo1, A. de la Torre2, A. Hervás3, A. Ruiz4, M. Martín1, O. Liñán1, M. López2, C. López5 1 Hospital Universitario La Princesa, Radiation Oncology, Madrid, Spain 2 Hospital Puerta de Hierro, Radiation Oncology, Madrid, Spain 3 Hospital Ramón y Cajal, Radiation Oncology, Madrid, Spain
4th ICHNO 4
Hospital Doce de Octubre, Radiation Oncology, Madrid, Spain Hospital de la Princesa, Pathology, Madrid, Spain
5
Purpose/Objective: To analyze the incidence of oropharyngeal squamous-cell carcinomas induced by human papillomavirus (HPV), and to determine the prognostic significance of HPV status among patients with oropharyngeal cancer treated with concurrent chemoradiotherapy. Materials and Methods: We performed a retrospective analysis on 102 patients with stage III-IV oropharyngeal cancer, treated with curative chemoradiotherapy in four university hospitals between 2000 and 2008. Immunohistochemical (IHC) expression of p16 was analyzed in matched pretreatment paraffin-embedded tumour blocks from these patients. Tumours were classified as p16 positive in case of a confluent nuclear and cytoplasmatic staining pattern, and p16 negative in case of absence of staining. Quantitative real-time polymerase chain reaction (qRT-PCR) assay for HPV16 mRNA was also performed. The influence of p16 status on disease-specific survival, and overall survival after treatment was evaluated. Results: p16 positivity by IHC was found in 27 tumours (26.7%). HPV16 E6 mRNA was positive in 10 tumours (10.5%). RNA integrity was very low, due to high RNA degradation in the deparaffinization process. All positive E6 mRNA patients were also positive by p16 ICH. No statistical significant differences were observed between the p16 positive and p16 negative groups regarding tumour stage, gender, age or tobacco use. Overall survival was improved for p16 positive tumours compared to p16 negative, with 5-year actuarial values of 74% versus 52% (p=0.053). Disease- free survival was also improved for HPV-positive patients, although not significantly (62.9% vs 48.3%, p=0.2, at 5 years). 3-year survival HR (confidence rates p interval) HPV + HPV Loco-regional 52.7% 51.1% 0.8 (0.44-1.45) 0.476 control Disease-free 54.6% 46.6% 0.65 (0.315-1.362) 0.258 survival Overall 67.4% 49.7% 0.55(0.24-1.25) 0.095 survival Conclusions: The incidence of HPV-related orophayngeal carcinomas in our region is similar to that reported in other European countries, and apparently lower than the incidence in North America. HPV-positivity by p16 IHC was associated with improved overall survival in patients treated with chemoradiation. PO-119 IMRT FOR OROPHARYNGEAL CARCINOMA: PRELIMINARY RESULTS FOCUSING ON THE IMPACT OF HPV STATUS AND RISK CATEGORIES E. Orlandi1, E. Iannacone1, L. Locati2, P. Bossi2, R. Granata2, M. Carrara3, E. Pignoli3, F. Perrone4, L. Licitra2, C. Fallai1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy 2, Milan, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck Medical Oncology, Milan, Italy 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics, Milan, Italy 4 Fondazione IRCCS Istituto Nazionale dei Tumori, Molecular Pathology, Milan, Italy Purpose/Objective: Recently, 3 groups of oropharyngeal cancer (OPC) patients (pts) with different outcomes were identified based on HPV status, smoking history and tumor stage. Aims of this study were: i) to estimate the risk groupstratified survivals in locally advanced OPC treated with Intensity Modulated Radiotherapy (IMRT); ii) to investigate
Purpose/Objective: Head and neck cancers (HNCa) are the most common cancers among males and third most common cancers overall in India and 70-80% patients present in advanced stage. Of these around 50% are eligible for curative, 35% for palliative radiotherapy and 15% for only supportive care. Palliative care and cancer directed treatment in advanced (HNCa) is not adequately studied. We did this Prospective study to assess symptom burden and quality of life in advanced HNCa patients suitable for Palliative radiotherapy. Materials and Methods: 100 patients who were suitable for Palliative Radiotherapy as decided in HNCa clinic were asked to fill EORTC QLQ C15-PAL Questionnaire which consisted of Global Quality of life (QOL), Physical Functioning (PF), Emotional Functioning (EF), fatigue (FA), Nausea & vomiting (NV), Pain (PA), Dyspnea (DY), sleep (SL), appetite (AP) and constipation (CO) and additional questions pertaining to swallowing (SW), hoarseness (HO), cough (CG), weight loss (WL), use of pain killers (PK), taste (TA), bleeding from tumour (BL), hearing (HE), pain in neck lump (PALMP), opening mouth (OM) and oral secretions (OS) based on a modified EORTC-HN35 questionnaire. Scoring was done to derive a score on 0-100 scale according to EORTC scoring Manual. Median and Range were calculated for each item for the entire cohort. Results: Of the 100 patients, 17 were Female and 83 were Male. 42% of them were more than or 60 years of age. 31 had carcinoma of Oral cavity, 46 of oropharynx, 14 of larynx and 9 others. 47 patients had Karnofsky performance status (KPS) of more than equal to 70. 66 patients had T4, 21 had T3, 34 had N2 and 32 had N3 disease. 10% of the patients had comorbidities. Median pack years of tobacco smoked was 35. 90% of the patients were tobacco consumers and of which 10% were also alcoholic. 82% of patients had education of below class 12th. Median QOL was 50 (Range 0-83.33) and PF was 77.78 (0-100). Median Score for EF and FA was 50. Median score for PA, SL, AP was 66.67. Median value for SW, HO, WL, BL, PALMP, CO and OS was 33.33 (100-0). While TA, CG, NV, DY and HE had a median score of 0.00. Conclusions: Advanced HNCa has a significant burden of symptoms. They report roughly loosing half their QOL. Though they maintain their PF at a higher level but have almost halving of EF. The top four symptoms are pain, Insomnia, loss of appetite and fatigue. Difficulty in swallowing, problem with oral secretions, difficulty in opening mouth and constipation are significant symptoms in our cohort of patients. We suggest each cancer centre should explore the symptom burden in their cohort of patients for identification of population and stage specific symptoms. These results would help in giving patients better symptom directed therapies and improve their quality of life.
POSTER: HPV RELATED H&N CANCER PO-118 INCIDENCE AND PROGNOSIS OF HPV INDUCED OROPHARYNGEAL CANCER IN A COHORT OF PATIENTS TREATED WITH CHEMORADIATION L. Cerezo1, A. de la Torre2, A. Hervás3, A. Ruiz4, M. Martín1, O. Liñán1, M. López2, C. López5 1 Hospital Universitario La Princesa, Radiation Oncology, Madrid, Spain 2 Hospital Puerta de Hierro, Radiation Oncology, Madrid, Spain 3 Hospital Ramón y Cajal, Radiation Oncology, Madrid, Spain
4th ICHNO 4
Hospital Doce de Octubre, Radiation Oncology, Madrid, Spain Hospital de la Princesa, Pathology, Madrid, Spain
5
Purpose/Objective: To analyze the incidence of oropharyngeal squamous-cell carcinomas induced by human papillomavirus (HPV), and to determine the prognostic significance of HPV status among patients with oropharyngeal cancer treated with concurrent chemoradiotherapy. Materials and Methods: We performed a retrospective analysis on 102 patients with stage III-IV oropharyngeal cancer, treated with curative chemoradiotherapy in four university hospitals between 2000 and 2008. Immunohistochemical (IHC) expression of p16 was analyzed in matched pretreatment paraffin-embedded tumour blocks from these patients. Tumours were classified as p16 positive in case of a confluent nuclear and cytoplasmatic staining pattern, and p16 negative in case of absence of staining. Quantitative real-time polymerase chain reaction (qRT-PCR) assay for HPV16 mRNA was also performed. The influence of p16 status on disease-specific survival, and overall survival after treatment was evaluated. Results: p16 positivity by IHC was found in 27 tumours (26.7%). HPV16 E6 mRNA was positive in 10 tumours (10.5%). RNA integrity was very low, due to high RNA degradation in the deparaffinization process. All positive E6 mRNA patients were also positive by p16 ICH. No statistical significant differences were observed between the p16 positive and p16 negative groups regarding tumour stage, gender, age or tobacco use. Overall survival was improved for p16 positive tumours compared to p16 negative, with 5-year actuarial values of 74% versus 52% (p=0.053). Disease- free survival was also improved for HPV-positive patients, although not significantly (62.9% vs 48.3%, p=0.2, at 5 years). 3-year survival HR (confidence rates p interval) HPV + HPV Loco-regional 52.7% 51.1% 0.8 (0.44-1.45) 0.476 control Disease-free 54.6% 46.6% 0.65 (0.315-1.362) 0.258 survival Overall 67.4% 49.7% 0.55(0.24-1.25) 0.095 survival Conclusions: The incidence of HPV-related orophayngeal carcinomas in our region is similar to that reported in other European countries, and apparently lower than the incidence in North America. HPV-positivity by p16 IHC was associated with improved overall survival in patients treated with chemoradiation. PO-119 IMRT FOR OROPHARYNGEAL CARCINOMA: PRELIMINARY RESULTS FOCUSING ON THE IMPACT OF HPV STATUS AND RISK CATEGORIES E. Orlandi1, E. Iannacone1, L. Locati2, P. Bossi2, R. Granata2, M. Carrara3, E. Pignoli3, F. Perrone4, L. Licitra2, C. Fallai1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy 2, Milan, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck Medical Oncology, Milan, Italy 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Physics, Milan, Italy 4 Fondazione IRCCS Istituto Nazionale dei Tumori, Molecular Pathology, Milan, Italy Purpose/Objective: Recently, 3 groups of oropharyngeal cancer (OPC) patients (pts) with different outcomes were identified based on HPV status, smoking history and tumor stage. Aims of this study were: i) to estimate the risk groupstratified survivals in locally advanced OPC treated with Intensity Modulated Radiotherapy (IMRT); ii) to investigate