Long-Term Follow-Up of E3311, an ECOG-ACRIN Cancer Research Group Phase II Trial of Transoral Surgery and Risk-Based Adjuvant Treatment in Human Papillomavirus–Initiated Oropharynx Cancer
Abstract
This phase II trial of transoral surgery (TOS) with deintensified postoperative management in human papillomavirus (HPV)–associated oropharynx cancer (OPC) enrolled patients with resectable cT1-2 stage III/IV American Joint Committee on Cancer (AJCC) seventh edition p16+ OPC without matted neck nodes. Those with clear margins, 0-1 + nodes (LN), and no extranodal extension (ENE) were observed (arm A); those with clear margins, 2-4 + LN, or ENE ≤1 mm were randomly assigned to 50 Gy (arm B) or 60 Gy (arm C); and those with involved margins, >4 + LN, or >1 mm ENE received weekly cisplatin and 60-66 Gy (arm D). Among 359 evaluable patients, the 54-month progression-free (PFS) and overall survival (OS) were 90.6% (90% CI, 87.2% to 93.1%) and 95.3% (93.0% to 96.9%), respectively. The 54-month PFS by arm was A 93.2% (79.6% to 97.8%; all four recurrences among N1 patients), B 94.9% (89.7% to 97.5%), C 90.2% (82.7% to 94.6%), and D 85.5% (77.5% to 90.8%). The 54-month OS by arm was A 97.1% (85.7% to 99.4%), B 97.9% (93.5% to 99.3%), C 95.1% (90.1% to 97.6%), and D 92.5% (86.9% to 95.7%). PFS or OS did not differ by primary site or smoking history. TOS and neck dissection with deintensified postoperative management results in outstanding 54-month PFS and OS. Among patients with favorable pathologic characteristics, those with N1 disease are at risk of late recurrence without radiation.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (21)
Barbara Burtness
Department of Internal Medicine and Yale Cancer Center, Yale School of Medicine, New Haven, CT
Yael Flamand
2Dana-Farber Cancer Institute, Department of Data Science, Boston, United States
Harry Quon
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD
Gregory S. Weinstein
University of Pennsylvania, Philadelphia, PA
Ranee Mehra
Joaquin J. Garcia
Seungwon Kim
Bert W. O'Malley
Enver Ozer
Department of Otolaryngology—Head and Neck Surgery, Ohio State University School of Medicine, Columbus, OH
Chukwuemeka Ikpeazu
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
Wayne M. Koch
Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD
Neil D. Gross
R. Bryan Bell
Providence Cancer Institute, Earle A. Chiles Research Institute, Portland, OR
Mihir Patel
Tulane University, New Orleans, Louisiana, United States
Miriam N. Lango
Department of Head and Neck Surgery, M. D. Anderson Cancer Center, Houston, TX
Luc G. Morris
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
Russell Smith
Daniel Karakla
Department of Otolaryngology—Head and Neck Surgery, Sentara Norfolk General Hospital, Norfolk, VA
Jeremy D. Richmon
Floyd C. Holsinger
Department of Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
Robert L. Ferris
UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA