Impact of HPV infection on the clinical outcome of p-CAIR trial in head and neck cancer.

Abstract

The purpose of the study was to analyse the influence of HPV infection on the outcome of a randomized clinical trial of conventional (CF) versus 7-days-a-week postoperative radiotherapy (p-CAIR) for squamous cell cancer of the head and neck (SCCHN). Between 2001 and 2004, 279 patients with high-risk SCC of the larynx or cancer of the oral cavity/oropharynx were randomized to receive 63 Gy in fractions of 1.8 Gy given 5 days a week or 7 days a week (Radiother Oncol 87:155-163, 2008). The presence of HPV DNA in 131 archival paraffin blocks was assessed with multiplex quantitative real-time PCR using five consensus primers for the conservative L1 region and molecular beacon probes targeting 14 high-risk HPV subtypes. Following the RT-PCR procedure, we could determine the presence and type of HPV16, HPV18 and the other 12 less frequent oncogenic subtypes. Out of 131 samples, 9 were positive for HPV infection (6.9%), all of them with HPV16 subtype. None of the 65 laryngeal tumours was HPV positive. The 5-year LRC in HPV-positive patients was 100%, compared to 58% in the HPV-negative group (p = 0.02, log-rank test). Amongst 122 patients with HPV-negative tumours, 5-year LRC was 50.3% in p-CF versus 65.2 in p-CAIR (p = 0.37). HPV infection was associated with low expression of EGFR and cyclin D. This study demonstrates a favourable outcome for HPV-positive patients with SCCHN treated with postoperative radiotherapy. While considering the small number of HPV+ tumours, the data set can be considered as hypothesis generating only, the outcome raises new questions on the necessity of aggressive postoperative treatment in HPV+ patients.

• Authors: Miroslaw Snietura, Wojciech Piglowski, Magdalena Jaworska, Anna Mucha-Malecka, Grzegorz Wozniak, Dariusz Lange, Rafal Suwinski
• Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 268 Issue 5 Pg. 721-6 (May 2011) ISSN: 1434-4726 [Electronic] Germany
• PMID: 20938670 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2010

Chemical References

• Biomarkers, Tumor
• DNA, Viral

Topics

• Adult
• Aged
• Biomarkers, Tumor (metabolism)
• Carcinoma, Squamous Cell (metabolism, radiotherapy, virology)
• DNA, Viral (analysis)
• Dose Fractionation, Radiation
• Female
• Head and Neck Neoplasms (metabolism, radiotherapy, virology)
• Human papillomavirus 16 (isolation & purification)
• Humans
• Laryngeal Neoplasms (radiotherapy, virology)
• Male
• Middle Aged
• Mouth Neoplasms (radiotherapy, virology)
• Neoplasm Recurrence, Local
• Oropharyngeal Neoplasms (radiotherapy, virology)
• Papillomavirus Infections (complications, diagnosis)
• Radiotherapy Dosage
• Randomized Controlled Trials as Topic
• Treatment Outcome