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| |  Nonsmokers With Oropharyngeal Cancer Fare Well With Radiation Treatment Alone If Disease Is HPV-Related: Presented at ASTRO By John Otrompke CHICAGO -- November 9, 2009 -- Due to changing etiology and epidemiology of oropharyngeal cancer over the past 25 years, patients who have never smoked and whose disease is related to human papillomavirus (HPV), may fare well under new methods when treated with radiation alone, according to a study presented here at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting. “Oropharyngeal cancer is more associated today with HPV as opposed to smoking, and patients tend to be 3 to 5 years younger at the time of diagnosis,” said Adam S. Garden, MD, Head and Neck Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, on November 3. Dr. Garden and colleagues conducted a retrospective review of 1,570 patients irradiated between 1980 and 2005 for stage III or IV oropharyngeal cancer. Patients who had surgery as their initial treatment were excluded from the analysis, but those with tonsillectomies or neck dissection were included. The study highlighted changes in treatment, etiology, and epidemiology for the condition over the past 25 years, Dr. Garden said. “Chemotherapy is more often used, and curative surgery less so, because it has been found not to be advantageous,” he explained. “The medical advances help smokers more than nonsmokers, but smokers still have worse outcomes,” he added, noting that many never-smokers experience an 85% cure rate. Another change has been a move to stratify studies based on disease etiology, according to Dr. Garden. “Outcomes are so much better for those with HPV-related disease, who have a better survival rate by 20% to 30%,” he explained. Smokers were defined as those who currently smoked, or had quit within the past year, former smokers as those who had quit more than 1 year ago, and never-smokers as those who had consumed fewer than 100 cigarettes in their lifetime. The study population included 588 current smokers, 473 former smokers, and 501 never-smokers. Of the smokers, 64% had stage 3 or 4 disease, compared with 38% of never-smokers. With 5-year follow-up, the rate of local-regional failure was 34% for smokers, 16% for former smokers, and 9% for never-smokers, while the distant failure rate was 25% for smokers, 15% for former smokers, and 11% for never-smokers. By comparison, for those treated without chemotherapy, 28% of smokers had 5-year distant failure rate, while for former smokers the number was 11%, and for never-smokers, it was 9%. Physicians began seeing the improved results for smokers between 2000 and 2005, according to Dr. Garden, who noted that smokers tend to get cancer a little later than those who get it due to HPV, because patients tend to be exposed to viruses at a younger age than to tobacco. [Presentation title: Patterns of Disease Recurrence Following Radiation for Oropharyngeal Cancer. Abstract 67]
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