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Treatment strategies in early-stage oropharyngeal squamous cell carcinoma: a French national survey

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Abstract

The objective of the study is to perform a national survey of practices in early-stage squamous cell carcinoma (SCC) of the oropharynx (base of tongue and tonsils) targeting surgical and non-surgical procedures in France. A questionnaire concerning practices in surgery, radiotherapy, HPV screening, and two clinical cases were sent to all centers participating in the French Head and Neck Oncology Society, and to public hospitals listed as authorized to treat head and neck cancer according to the French National Cancer Institute (INCa). Sixty-four teams comprising almost all the University Hospitals and most of the Comprehensive Cancer Centers completed the survey questionnaire and responded to the clinical cases. Surgical and radiotherapy strategies were used in similar measure for early-stage SCC of the base of the tongue while tonsil lesions were mainly treated with surgery. The main arguments were disease control for the teams offering patients surgery, and functional results for those offering radiotherapy. However, concomitant chemoradiotherapy was chosen more frequently than radiotherapy alone in early-stage SCC of the base of tongue. Age and tobacco–alcohol addiction were decisive criteria in decision making for the majority of the teams. French oncology teams offered surgical and radiotherapy strategies in similar measure to treat early-stage SCC of the oropharynx (base of tongue and tonsils) as well as a high rate of multimodality therapy. Decision making was guided by the desire to achieve oncologic results adapted to the patient and his age, as well as functional preservation taking into account life expectancy.

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References

  1. Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, Jiang B, Goodman MT, Sibug-Saber M, Cozen W, Liu L, Lynch CF, Wentzensen N, Jordan RC, Altekruse S, Anderson WF, Rosenberg PS, Gillison ML (2011) Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 29(32):4294–4301. doi:10.1200/JCO.2011.36.4596

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fakhry C, Westra WH, Li S, Cmelak A, Ridge JA, Pinto H, Forastiere A, Gillison ML (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 100(4):261–269. doi:10.1093/jnci/djn011

    Article  CAS  PubMed  Google Scholar 

  3. Parsons JT, Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Villaret DB, Moore-Higgs GJ, Greene BD, Speer TW, Cassisi NJ, Million RR (2002) Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer 94(11):2967–2980. doi:10.1002/cncr.10567

    Article  PubMed  Google Scholar 

  4. Weinstein GS, O’Malley BW Jr, Magnuson JS, Carroll WR, Olsen KD, Daio L, Moore EJ, Holsinger FC (2012) Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 122(8):1701–1707. doi:10.1002/lary.23294

    Article  PubMed  Google Scholar 

  5. Lapeyre M, Biau J, Miroir J, Servagi-Vernat S, Giraud P (2014) Intensity-modulated radiotherapy in head and neck cancer: ethics and methodology. Cancer Radiother 18(5–6):365–368. doi:10.1016/j.canrad.2014.06.005

    Article  CAS  PubMed  Google Scholar 

  6. Pfister DG, Ang KK, Brizel DM, Burtness BA, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL Jr, Hitchcock YJ, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mittal BB, Pinto HA, Ridge JA, Samant S, Sanguineti G, Schuller DE, Shah JP, Spencer S, Trotti A 3rd, Weber RS, Wolf GT, Worden F, National Comprehensive Cancer N (2011) Head and neck cancers. J Natl Compr Cancer Netw 9(6):596–650

    Google Scholar 

  7. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363(1):24–35. doi:10.1056/NEJMoa0912217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Licitra L, Bernier J, Grandi C, Merlano M, Bruzzi P, Lefebvre JL (2002) Cancer of the oropharynx. Crit Rev Oncol Hematol 41(1):107–122

    Article  PubMed  Google Scholar 

  9. Mendenhall WM, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ (2000) Radiation therapy for squamous cell carcinoma of the tonsillar region: a preferred alternative to surgery? J Clin Oncol 18(11):2219–2225

    CAS  PubMed  Google Scholar 

  10. Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Moore-Higgs GJ, Cassisi NJ (2000) Is radiation therapy a preferred alternative to surgery for squamous cell carcinoma of the base of tongue? J Clin Oncol 18(1):35–42

    CAS  PubMed  Google Scholar 

  11. Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Bertrand P (1999) Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 91(24):2081–2086

    Article  CAS  PubMed  Google Scholar 

  12. Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G (2004) Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22(1):69–76. doi:10.1200/JCO.2004.08.021

    Article  PubMed  Google Scholar 

  13. Pignon JP, le Maitre A, Maillard E, Bourhis J, Group M-NC (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92(1):4–14. doi:10.1016/j.radonc.2009.04.014

    Article  PubMed  Google Scholar 

  14. Chen AY, Zhu J, Fedewa S (2014) Temporal trends in oropharyngeal cancer treatment and survival: 1998–2009. Laryngoscope 124(1):131–138. doi:10.1002/lary.24296

    Article  PubMed  Google Scholar 

  15. Chao KS, Majhail N, Huang CJ, Simpson JR, Perez CA, Haughey B, Spector G (2001) Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol 61(3):275–280

    Article  CAS  PubMed  Google Scholar 

  16. de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, Stambuk H, Pfister D, Kraus D, Shaha A, Shah J, Lee NY (2006) Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 64(2):363–373. doi:10.1016/j.ijrobp.2005.03.006

    Article  PubMed  Google Scholar 

  17. Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A, Mechalakos J, Venkatraman ES, Kraus D, Shaha A, Shah JP, Pfister DG, Zelefsky MJ (2006) A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 66(4):966–974. doi:10.1016/j.ijrobp.2006.06.040

    Article  PubMed  Google Scholar 

  18. O’Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116(8):1465–1472. doi:10.1097/01.mlg.0000227184.90514.1a

    Article  PubMed  Google Scholar 

  19. Weinstein GS, O’Malley BW Jr, Snyder W, Sherman E, Quon H (2007) Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 133(12):1220–1226. doi:10.1001/archotol.133.12.1220

    Article  PubMed  Google Scholar 

  20. Moore EJ, Olsen SM, Laborde RR, Garcia JJ, Walsh FJ, Price DL, Janus JR, Kasperbauer JL, Olsen KD (2012) Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc 87(3):219–225. doi:10.1016/j.mayocp.2011.10.007

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hans S, Badoual C, Gorphe P, Brasnu D (2011) Transoral robotic surgery for head and neck carcinomas. Eur Arch Otorhinolaryngol 269(8):1979–1984. doi:10.1007/s00405-011-1865-7

    Article  PubMed  Google Scholar 

  22. Park YM, Kim WS, Byeon HK, Lee SY, Kim SH (2012) Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer. Br J Oral Maxillofac Surg. doi:10.1016/j.bjoms.2012.08.015

    Google Scholar 

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Acknowledgments

The authors are very grateful to all the members of the GORTEC–GETTEC network and of the French Society of Head and Neck Oncology, for their massive participation and their very constructive comments. The authors thank Lorna Saint Ange for English editing.

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Authors and Affiliations

  1. Département de Cancérologie Cervico-Faciale, Gustave Roussy, 94805, Villejuif, France

    Philippe Gorphe

  2. Département de Radiothérapie, Gustave Roussy, 94805, Villejuif, France

    Pierre Blanchard

  3. Département d’ORL et Chirurgie Cervico-Faciale, CHU Bretonneau, 2 boulevard Tonnellé, 37000, Tours, France

    Sylvain Morinière

  4. Service d’ORL et Chirurgie Cervico-Faciale, CHU La Timone, Aix Marseille Université, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France

    Nicolas Fakhry

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  1. Philippe Gorphe
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  4. Nicolas Fakhry
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Correspondence to Philippe Gorphe.

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Gorphe, P., Blanchard, P., Morinière, S. et al. Treatment strategies in early-stage oropharyngeal squamous cell carcinoma: a French national survey. Eur Arch Otorhinolaryngol 273, 2201–2207 (2016). https://doi.org/10.1007/s00405-015-3744-0

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  • DOI: https://doi.org/10.1007/s00405-015-3744-0

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