Main Session
Sep
30
QP 08 - Head and Neck 3: Quick Pitch: Prognosis in Focus: Predicting Outcomes in Head and Neck Cancer
1043 - Prognostic Implications of Detectable Postoperative Tumor Tissue-Modified HPV DNA in Patients with p16+ Oropharyngeal Squamous Cell Carcinoma Undergoing De-Intensified Adjuvant Radiation
Presenter(s)
Matthew Riina, MD - Hospital of the University of Pennsylvania, Philadelphia, PA
M. D. Riina1, E. MacDuffie2, A. Ramkissoon3, R. J. L. Maxwell2, A. Lin4, D. Basu5, R. Brody5, S. B. Cannady6, R. M. Carey6, A. Chalian6, K. Rajasekaran6, C. Rassekh6, G. S. Weinstein6, R. Cohen7, A. Singh7, L. Sun7, K. Montone3, and J. N. Lukens3; 1h, Boston, MA, 2Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 3University of Pennsylvania, Philadelphia, PA, 4University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, 5U. Pennsylvania, Philadelphia, PA, 6Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, 7Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s):
Tumor tissue modified human papillomavirus (TTMV-HPV) DNA assays are widely utilized for surveillance in patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC). However, the prognostic implications of detectable postoperative TTMV-HPV DNA remain uncertain. We sought to evaluate the association between detectable postoperative TTMV-HPV DNA and clinical outcomes in patients with p16+ OPSCC treated with transoral robotic surgery (TORS) and de-intensified adjuvant radiation (D-I aRT).Materials/Methods:
We analyzed patients with p16+ OPSCC treated with TORS and D-I aRT +/- chemotherapy at a high volume center from 2018-2023 who had post-TORS, pre-radiation TTMV-HPV DNA levels available. Patients were stratified by postoperative TTMV-HPV DNA status (detectable vs undetectable). Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated from completion of RT, estimated using the Kaplan-Meier method, and compared between patients with detectable and undetectable TTMV-HPV DNA by the log-rank test.Results:
Ninety-one patients meeting inclusion criteria were identified. Median follow-up was 38 months. Nine patients (9.9%) had detectable postoperative TTMV-HPV DNA with a median concentration of 14.3 copies/µL (range 4.0-4421 copies/µL). The outcomes of patients with detectable postoperative TTMV-HPV DNA are shown in Table 1. No patients with detectable TTMV-HPV DNA experienced LRF and three year LRFFS was not significantly different between patients with detectable (100%, 95% CI 100%-100%) and undetectable (98.8%, 95% CI 96.3%-100%) TTMV-HPV DNA (p=0.7). Three patients with detectable TTMV-HPV DNA developed DM (33.3%), two of whom had levels >1000 copies/µL. Three year DMFS was significantly lower for patients with detectable TTMV-HPV DNA (66.7%, 95% CI 42.0%–100%) compared to those with undetectable levels (94.9%, 95% CI 90.2%–99.9%) (p<0.0001). Two patients in this cohort died, both after developing metastatic disease. Three year OS was significantly lower for patients with detectable TTMV-HPV DNA (87.5%, 95% CI: 67.3%–100%) compared to those with undetectable levels (100%, 95% CI 100%–100%) (p<0.01).Conclusion:
Detectable TTMV-HPV DNA after TORS in patients with p16+ OPSCC undergoing D-I aRT is associated with worse three-year DMFS and OS but does not impact LRFFS. Patients with low positive postoperative TTMV-HPV DNA may be salvaged by DI-aRT while patients with levels >1000 copies/µL may be at higher risk of DM. These findings should be validated in a larger cohort. Table 1:| Patient | Postoperative TTMV-HPV DNA (copies/µL) | Local Failure | Distant Metastases |
| 01 | 4.0 | No | No |
| 02 | 4.2 | No | Yes |
| 03 | 6.2 | No | No |
| 04 | 10.0 | No | No |
| 05 | 14.3 | No | No |
| 06 | 20.4 | No | No |
| 07 | 33.9 | No | No |
| 08 | 1077 | No | Yes |
| 09 | 4421 | No | Yes |