Author: Mark Leiser

DALLAS — Treatment modality for HPV-positive oropharyngeal squamous cell carcinoma varied considerably by facility type, according to study results.

The findings — presented at American Head & Neck Society Annual Meeting — showed academic hospitals more frequently utilized surgery instead of radiation therapy or chemoradiation therapy alone as the primary treatment modality for early- and late-stage cancers.

The findings suggest a lack of standardized treatment regimens that prevent patients from receiving universal care independent of facility resources, Monica S. Trent, MD, first-year resident at University of California, Irvine, and colleagues concluded.

“There are many different ways to treat HPV-positive oropharyngeal squamous cell carcinoma and, in order to try to determine the best treatment option, it is important to know who is offering what types of treatment at different centers,” Trent told Healio. “Our results show patients are being treated differently depending on where they present, and treatment is not standardized across different types of facilities.”

Background and methods
HPV-positive oropharyngeal squamous cell carcinoma is distinct from HPV-negative disease. It more frequently affects younger, healthier patients, and it is associated with improved prognosis and better historical survival outcomes after standard radiation and chemoradiation treatment protocols.

The development of transoral robotic surgery offers an alternative upfront treatment option that could reduce short- and long-term morbidity without compromising oncologic outcomes, according to study background. However, due to the required resources and training needed for this modality, it has been offered primarily at academic medical centers.

Trent and colleagues retrospectively analyzed treatment trends in HPV-positive orpharyngeal cancer. They hypothesized that patients treated at academic high-volume teaching/research facilities would undergo upfront surgery more often than those treated at non-academic centers.

Researchers used the National Cancer Database to identify cases of histologically confirmed HPV-positive oropharyngeal cancer between 2010 and 2016.

Key findings
The analysis included 30,243 patients with HPV-positive oropharyngeal cancer. A comparable percentage underwent treatment at academic centers (49.9%) and non-academic centers (50.1%).

A higher percentage of patients treated at academic centers were younger (age 40 to 64 years, 72.2% vs. 68.9%; P < .001) and non-white (7.3% vs. 5.4%; P < .001). They also more frequently had stage I disease (3.7% vs. 3.3%; P < .001) or stage IV disease (72.9% vs. 69.8%; P < .001).

Results showed a significantly higher percentage of patients treated at academic centers than non-academic centers underwent surgery. Researchers observed this trend among patients with stage I/stage II disease (72.9% vs. 60.6%; P < .001) and those with stage III/stage IV disease (35.7% vs. 30.3%; P < .001).

Patients treated at non-academic centers more frequently received radiation only (stage I/stage II, 22.9% vs. 15%; P < .001; stage III/stage IV, 7.4% vs. 6.7%; P < .001) or chemoradiation (16.5% vs. 12%; P < .001; stage III/stage IV, 62.3% vs. 57.5%; P < .001).

Trent and colleagues offered several possible explanations for these results, including the potential role of transoral robotic surgery at academic centers, the distribution of specialists and patient self-selection.

“Perhaps patients who are more interested in undergoing surgery would be more likely to present to academic centers,” Trent said. “Another possibility is the multidisciplinary care teams at academic centers, who help guide treatment for these very complex patients.”

Because trends in surgery vary between academic and non-academic centers, it is important to investigate how quality of life for these patients differs with surgical treatments compared with other modalities, Trent said.

“There are studies looking into quality-of-life comparisons between radiation therapy and surgical therapy, and there is some evidence that long-term therapy in terms of radiation could be worse for patients over time,” Trent told Healio. “It is important for us to know the differences between patients treated with one modality vs. another.”