Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy

M. Vatca; J. T. Lucas; J. Laudadio; R. B. D'Agostino; J. D. Waltonen; C. A. Sullivan; R. Rouchard-Plasser; M. Matsangou; J. D. Browne; K. M. Greven; M. Porosnicu

doi:10.1016/j.oraloncology.2014.06.010

Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy

M. Vatca, J. T. Lucas, J. Laudadio, R. B. D'Agostino, J. D. Waltonen, C. A. Sullivan, R. Rouchard-Plasser, M. Matsangou, J. D. Browne, K. M. Greven, M. Porosnicu^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

39 Scopus citations

Abstract

Objectives The standard concurrent radiotherapy and chemotherapy regimens for patients with oropharyngeal cancer are highly toxic. Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has recently emerged as a distinct biological and clinical entity with improved response to treatment and prognosis. A tailored therapeutic approach is needed to optimize patient care. The aim of our study was to investigate the impact of HPV and smoking status on early toxicities (primarily mucositis) associated with concurrent chemotherapy and radiotherapy in patients with OPSCC. Materials and methods We retrospectively evaluated 72 consecutive patients with OPSCC and known HPV status treated with concurrent radiotherapy and chemotherapy at our institution. Treatment-related toxicities were stratified by smoking and HPV status and compared using univariate and multivariate logistic regression. Results HPV-positive patients had a 6.86-fold increase in the risk of having severe, grade 3-4 mucositis. This effect was preserved after adjusting for patient smoking status, nodal stage, radiotherapy technique and radiotherapy maximum dose. Additionally, HPV status had significant effect on the objective weight loss during treatment and at three months after treatment. Consistently, non-smokers had a significant 2.70-fold increase in the risk of developing severe mucositis. Conclusion Risk factors for OPSCC modify the incidence of treatment-related early toxicities, with HPV-positive and non-smoking status correlating with increased risk of high grade mucositis and associated outcomes. Retrospective single-institution studies need to be interpreted cautiously. However, this finding is important to consider when designing therapeutic strategies for HPV-positive patients and merits further investigation in prospective clinical trials.

Original language	English (US)
Pages (from-to)	869-876
Number of pages	8
Journal	Oral Oncology
Volume	50
Issue number	9
DOIs	https://doi.org/10.1016/j.oraloncology.2014.06.010
State	Published - Sep 2014

Funding

The authors also thank Megan J. Whelen, MPH (supported by the Comprehensive Cancer Center of Wake Forest University) for copyediting, editorial and production assistance and Karen Potvin Klein, MA, ELS (supported by the Biomedical Research Services Administration, Wake Forest School of Medicine) for copyediting and editorial assistance; Susan Butler, PhD (Department of Otolaryngology, Wake Forest School of Medicine) for her contribution to the study concepts and manuscript review; and Amy Franklin, PA-C (Section on Hematology and Oncology, Wake Forest School of Medicine) for her contribution to data collection and manuscript review. The authors also thank the Department of Pathology of Wake Forest School of Medicine for financial support, the Wake Forest School of Medicine Molecular Diagnostics Lab for performing the IHC and ISH, and Access Genetics for interpretation of the HPV genotyping. This work was supported in part by the Wake Forest Translational Science Institute KL2 Research Scholar program. Biostatistical services were provided by the Comprehensive Cancer Center of Wake Forest University NCI CCSG P30CA012197 grant.

Keywords

Chemotherapy
Human papillomavirus
Oral mucositis
Radiotherapy
Smoking
Squamous cell of head and neck

ASJC Scopus subject areas

Oral Surgery
Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.oraloncology.2014.06.010

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Vatca, M., Lucas, J. T., Laudadio, J., D'Agostino, R. B., Waltonen, J. D., Sullivan, C. A., Rouchard-Plasser, R., Matsangou, M., Browne, J. D., Greven, K. M., & Porosnicu, M. (2014). Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy. Oral Oncology, 50(9), 869-876. https://doi.org/10.1016/j.oraloncology.2014.06.010

@article{14b4063eb86b45a290c753c97ae2989f,

title = "Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy",

abstract = "Objectives The standard concurrent radiotherapy and chemotherapy regimens for patients with oropharyngeal cancer are highly toxic. Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has recently emerged as a distinct biological and clinical entity with improved response to treatment and prognosis. A tailored therapeutic approach is needed to optimize patient care. The aim of our study was to investigate the impact of HPV and smoking status on early toxicities (primarily mucositis) associated with concurrent chemotherapy and radiotherapy in patients with OPSCC. Materials and methods We retrospectively evaluated 72 consecutive patients with OPSCC and known HPV status treated with concurrent radiotherapy and chemotherapy at our institution. Treatment-related toxicities were stratified by smoking and HPV status and compared using univariate and multivariate logistic regression. Results HPV-positive patients had a 6.86-fold increase in the risk of having severe, grade 3-4 mucositis. This effect was preserved after adjusting for patient smoking status, nodal stage, radiotherapy technique and radiotherapy maximum dose. Additionally, HPV status had significant effect on the objective weight loss during treatment and at three months after treatment. Consistently, non-smokers had a significant 2.70-fold increase in the risk of developing severe mucositis. Conclusion Risk factors for OPSCC modify the incidence of treatment-related early toxicities, with HPV-positive and non-smoking status correlating with increased risk of high grade mucositis and associated outcomes. Retrospective single-institution studies need to be interpreted cautiously. However, this finding is important to consider when designing therapeutic strategies for HPV-positive patients and merits further investigation in prospective clinical trials.",

keywords = "Chemotherapy, Human papillomavirus, Oral mucositis, Radiotherapy, Smoking, Squamous cell of head and neck",

author = "M. Vatca and Lucas, {J. T.} and J. Laudadio and D'Agostino, {R. B.} and Waltonen, {J. D.} and Sullivan, {C. A.} and R. Rouchard-Plasser and M. Matsangou and Browne, {J. D.} and Greven, {K. M.} and M. Porosnicu",

note = "Funding Information: The authors also thank Megan J. Whelen, MPH (supported by the Comprehensive Cancer Center of Wake Forest University) for copyediting, editorial and production assistance and Karen Potvin Klein, MA, ELS (supported by the Biomedical Research Services Administration, Wake Forest School of Medicine) for copyediting and editorial assistance; Susan Butler, PhD (Department of Otolaryngology, Wake Forest School of Medicine) for her contribution to the study concepts and manuscript review; and Amy Franklin, PA-C (Section on Hematology and Oncology, Wake Forest School of Medicine) for her contribution to data collection and manuscript review. The authors also thank the Department of Pathology of Wake Forest School of Medicine for financial support, the Wake Forest School of Medicine Molecular Diagnostics Lab for performing the IHC and ISH, and Access Genetics for interpretation of the HPV genotyping. Funding Information: This work was supported in part by the Wake Forest Translational Science Institute KL2 Research Scholar program. Biostatistical services were provided by the Comprehensive Cancer Center of Wake Forest University NCI CCSG P30CA012197 grant. ",

year = "2014",

month = sep,

doi = "10.1016/j.oraloncology.2014.06.010",

language = "English (US)",

volume = "50",

pages = "869--876",

journal = "Oral Oncology",

issn = "1368-8375",

publisher = "Elsevier Ltd",

number = "9",

}

Vatca, M, Lucas, JT, Laudadio, J, D'Agostino, RB, Waltonen, JD, Sullivan, CA, Rouchard-Plasser, R, Matsangou, M, Browne, JD, Greven, KM & Porosnicu, M 2014, 'Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy', Oral Oncology, vol. 50, no. 9, pp. 869-876. https://doi.org/10.1016/j.oraloncology.2014.06.010

TY - JOUR

T1 - Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy

AU - Vatca, M.

AU - Lucas, J. T.

AU - Laudadio, J.

AU - D'Agostino, R. B.

AU - Waltonen, J. D.

AU - Sullivan, C. A.

AU - Rouchard-Plasser, R.

AU - Matsangou, M.

AU - Browne, J. D.

AU - Greven, K. M.

AU - Porosnicu, M.

N1 - Funding Information: The authors also thank Megan J. Whelen, MPH (supported by the Comprehensive Cancer Center of Wake Forest University) for copyediting, editorial and production assistance and Karen Potvin Klein, MA, ELS (supported by the Biomedical Research Services Administration, Wake Forest School of Medicine) for copyediting and editorial assistance; Susan Butler, PhD (Department of Otolaryngology, Wake Forest School of Medicine) for her contribution to the study concepts and manuscript review; and Amy Franklin, PA-C (Section on Hematology and Oncology, Wake Forest School of Medicine) for her contribution to data collection and manuscript review. The authors also thank the Department of Pathology of Wake Forest School of Medicine for financial support, the Wake Forest School of Medicine Molecular Diagnostics Lab for performing the IHC and ISH, and Access Genetics for interpretation of the HPV genotyping. Funding Information: This work was supported in part by the Wake Forest Translational Science Institute KL2 Research Scholar program. Biostatistical services were provided by the Comprehensive Cancer Center of Wake Forest University NCI CCSG P30CA012197 grant.

PY - 2014/9

Y1 - 2014/9

N2 - Objectives The standard concurrent radiotherapy and chemotherapy regimens for patients with oropharyngeal cancer are highly toxic. Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has recently emerged as a distinct biological and clinical entity with improved response to treatment and prognosis. A tailored therapeutic approach is needed to optimize patient care. The aim of our study was to investigate the impact of HPV and smoking status on early toxicities (primarily mucositis) associated with concurrent chemotherapy and radiotherapy in patients with OPSCC. Materials and methods We retrospectively evaluated 72 consecutive patients with OPSCC and known HPV status treated with concurrent radiotherapy and chemotherapy at our institution. Treatment-related toxicities were stratified by smoking and HPV status and compared using univariate and multivariate logistic regression. Results HPV-positive patients had a 6.86-fold increase in the risk of having severe, grade 3-4 mucositis. This effect was preserved after adjusting for patient smoking status, nodal stage, radiotherapy technique and radiotherapy maximum dose. Additionally, HPV status had significant effect on the objective weight loss during treatment and at three months after treatment. Consistently, non-smokers had a significant 2.70-fold increase in the risk of developing severe mucositis. Conclusion Risk factors for OPSCC modify the incidence of treatment-related early toxicities, with HPV-positive and non-smoking status correlating with increased risk of high grade mucositis and associated outcomes. Retrospective single-institution studies need to be interpreted cautiously. However, this finding is important to consider when designing therapeutic strategies for HPV-positive patients and merits further investigation in prospective clinical trials.

AB - Objectives The standard concurrent radiotherapy and chemotherapy regimens for patients with oropharyngeal cancer are highly toxic. Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has recently emerged as a distinct biological and clinical entity with improved response to treatment and prognosis. A tailored therapeutic approach is needed to optimize patient care. The aim of our study was to investigate the impact of HPV and smoking status on early toxicities (primarily mucositis) associated with concurrent chemotherapy and radiotherapy in patients with OPSCC. Materials and methods We retrospectively evaluated 72 consecutive patients with OPSCC and known HPV status treated with concurrent radiotherapy and chemotherapy at our institution. Treatment-related toxicities were stratified by smoking and HPV status and compared using univariate and multivariate logistic regression. Results HPV-positive patients had a 6.86-fold increase in the risk of having severe, grade 3-4 mucositis. This effect was preserved after adjusting for patient smoking status, nodal stage, radiotherapy technique and radiotherapy maximum dose. Additionally, HPV status had significant effect on the objective weight loss during treatment and at three months after treatment. Consistently, non-smokers had a significant 2.70-fold increase in the risk of developing severe mucositis. Conclusion Risk factors for OPSCC modify the incidence of treatment-related early toxicities, with HPV-positive and non-smoking status correlating with increased risk of high grade mucositis and associated outcomes. Retrospective single-institution studies need to be interpreted cautiously. However, this finding is important to consider when designing therapeutic strategies for HPV-positive patients and merits further investigation in prospective clinical trials.

KW - Chemotherapy

KW - Human papillomavirus

KW - Oral mucositis

KW - Radiotherapy

KW - Smoking

KW - Squamous cell of head and neck

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U2 - 10.1016/j.oraloncology.2014.06.010

DO - 10.1016/j.oraloncology.2014.06.010

M3 - Article

C2 - 24998139

AN - SCOPUS:84905901223

SN - 1368-8375

VL - 50

SP - 869

EP - 876

JO - Oral Oncology

JF - Oral Oncology

IS - 9

ER -

Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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