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OBJECTIVES: Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, peri-neural spread (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial. MATERIALS AND METHODS: We retrospectively analyzed 73 patients at a single institution from 2008–2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS). RESULTS: Median age at diagnosis was 61 years (range 40–86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p=0.0008) and worse OS (3.97 p=0.0008). Patients who relapsed

Background The prognostic value of pretreatment complete blood count (CBC) data, including absolute lymphocyte count (ALC) and the neutrophil-to-lymphocyte ratio (NLR), has been reported for many diseases with decreased ALC and increased absolute neutrophil count (ANC) and NLR values correlating with worse outcomes. There is minimal data relating these hematologic parameters to oropharyngeal squamous cell carcinoma (OPSCC) prognosis. This study evaluates the prognostic value of pretreatment CBC data in OPSCC on overall survival (OS) and progression-free survival (PFS) in relation to HPV status. Methods A single-institutional retrospective review of patients with pretreatment hematologic data who received radiation for OPSCC was performed. Univariate and multivariate (UVA/MVA) Cox proportional hazard regression analyses were performed to identify prognostic variables. Translational studies related outcomes to the degree of tumor-infiltrating lymphocytes (TILs) in histologic specimens. Results From 2007 to 2018, 201 patients were treated for OPSCC. Median follow-up was 40 months. 3-year OS was 86.2% in the HPV-positive cohort, 46.3% for HPV-negative. Median NLR was 3.04. NLR ≥ 3 was associated with worse PFS (HR 1.67, p = 0.044. In the subset of 158 HPV + patients, MVA revealed increasing ALC to be associated with improved OS (HR 0.53; p = 0.040) and PFS (HR = 0.48; p = 0.0075). On UVA, high-TIL infiltration at diagnosis was associated with improved OS. Conclusion In a cohort of HPV + OPSCC patients, increasing ALC is associated with improved OS and PFS. Our study is the first to identify pre-treatment ALC as an independent prognostic factor in HPV-associated OPSCC.

OBJECTIVES: Recurrence rates for head and neck squamous cell carcinoma (HNSCC) approach 50% at 5 years. Current staging fails to identify patients with a worse prognosis who might benefit from intensified treatment, which warrants improved prognostic biomarkers. The purpose of this retrospective case study is to identify potential prognostic biomarkers in patients with HNSCC including APE1 (DNA repair/redox gene regulator), NRF2 and PPARGC1A (redox gene regulators), SOD3 and DCN (antioxidant proteins). MATERIALS AND METHODS: Differential protein expression between benign, carcinoma in situ (CIS), and invasive HNSCC tissue specimens from 77 patients was assessed using immunohistochemistry. Protein expression was analyzed with multivariate, pair-wise, and Kaplan-Meier survival analyses to identify potential prognostic biomarkers. Utilizing The Cancer Genome Atlas’s transcriptome database, pair-wise and survival analysis was performed to identify potential prognostic biomarkers. RESULTS: APE1, NRF2, PPARGC1A, SOD3, and DCN expression in HNSCC in relation to, lymph node invasion, and patient survival were examined. Elevated APE1 protein expression in CIS corresponded with reduced survival (p=0.0243). Increased APE1 gene expression in stage T4a HNSCC was associated with reduced patient survival (p

Purpose Head and neck (H&N) cancers arising in previously irradiated volumes were rarely treated with radiotherapy due to concerns of toxicity. With improved precision in planning and delivery, reirradiation has been increasingly used. We reviewed our institutional experience using IMRT in the management of previously irradiated H&N carcinoma. Materials and methods The records of 136 patients treated with IMRT reirradiation at U.T. M.D. Anderson Cancer Center for H&N cancer between 1999 and 2012 were retrospectively reviewed. Reirradiation was defined as any overlap between the two radiation treatment volumes. Severe toxicity related to reirradiation included events requiring hospitalization, urgent intervention, or death. Survival estimates were calculated using the Kaplan–Meier algorithm, excluding those patients treated with palliative intent. Results Thirty-three (24%) patients underwent surgical resection and 70 (51%) patients received chemotherapy. Twenty of these patients received radiation with palliative intent. Median time interval between initial radiation and reirradiation was 23 months. Median follow-up after reirradiation was 33 months. Median reirradiation dose was 60 Gy (range 15–70 Gy), while the median cumulative radiation dose was 120 Gy. The 2- and 5-year overall survival and locoregional control rates were 58% and 63%, and 39% and 51%, respectively. Re-treatment doses ⩾66 Gy trended towards improved LRC ( p = 0.14). Severe reirradiation related toxicity occurred in 35 patients (26%), including three treatment-related deaths. Severe toxicity did not correlate with total or re-treatment dose but was associated with retreatment volumes >150 cc. Conclusions IMRT yields promising local control and survival outcomes in select patients receiving reirradiation for H&N cancer. However, treatment related toxicity continues to be significant despite the increased conformality of IMRT over 3D conformal radiation. Alternative treatment strategies, including the possible use of stereotactic radiotherapy, to further improve conformality and thereby increase the therapeutic ratio, may be explored in the future.