Patterns of Distant Failure and Second Primary Cancers in Patients with Oropharyngeal Squamous Cell Carcinoma: Implications for Surveillance Methodology

Edwin F. Crandley; David D. Wilson; Austin J. Sim; Neil Majithia; Edward B. Stelow; Mark J. Jameson; David C. Shonka Jr.; Asal S. Rahimi; Paul W. Read

doi:10.6000/1929-2279.2014.03.03.5

Authors

Edwin F. Crandley Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
David D. Wilson Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
Austin J. Sim Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
Neil Majithia Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
Edward B. Stelow Department of Pathology, University of Virginia, P.O. Box 800904, Charlottesville, VA 22908, USA
Mark J. Jameson Department of Otolaryngology – Head and Neck Surgery, University of Virginia, P.O. Box 800713, Charlottesville, VA 22908, USA
David C. Shonka Jr. Department of Otolaryngology – Head and Neck Surgery, University of Virginia, P.O. Box 800713, Charlottesville, VA 22908, USA
Asal S. Rahimi Department of Radiation Oncology, University of Texas – Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
Paul W. Read Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA

DOI:

https://doi.org/10.6000/1929-2279.2014.03.03.5

Keywords:

Oropharynx cancer, surveillance, survivorship care, distant metastasis, second primary cancer.

Abstract

Background: We analyzed the pattern of distant metastasis (DM) and secondary primary cancers (SPC) in patients with oropharyngeal squamous cell carcinoma (OPSCC) to develop surveillance guidelines.

Methods: A retrospective review of 177 patients with OPSCC treated with intensity modulated radiation therapy ± chemotherapy between 2002 and 2012 was performed to characterize the rate, pattern, and timing of DM and SPC.

Results: Sixteen patients (9.0%) developed DM and 9 patients (5.1%) developed a SPC. Overall, 24/177 patients (13.6%) developed a DM and/or SPC for a total of 27 events. 92.6% (25/27) of events were detectable on physical exam and/or chest CT. p16+ patients developed DM later than p16- tumors (23.4 months versus 8.7 months).

Conclusions: Chest CT with physical examination detects the majority of DM and SPC in patients with OPSCC and would provide effective surveillance in these patients. A risk adapted surveillance strategy is proposed.

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