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In response to Letter to the Editor regarding: Primary surgery versus primary radiation‐based treatment for locally advanced oropharyngeal cancer
Author(s) -
Kamran Sophia C.,
Qureshi Muhammad M.,
Truong Minh Tam
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27642
Subject(s) - radiation oncology , medicine , medical school , general hospital , family medicine , library science , radiation therapy , medical education , computer science
We thank Gunduz et al. for their comments on our study evaluating practice patterns and overall survival outcomes for locally advanced oropharyngeal cancer using the National Cancer Database (NCDB). We found that primary surgery with adjuvant radiation ± chemotherapy (aRT ± CT) led to superior survival outcomes compared to primary radiation-based treatment. Gunduz et al. asked for clarification of Figures 1A and 1B, as well as for analysis in the context of the updated AJCC 8th edition, which provides major changes for HPV + oropharyngeal cancers. Regarding Figures 1A and 1B, we have included updated figures with clear demarcations at 3-year survival cutoff. As evident from the new figures, our statements in the Results section of our article for 3-year actuarial survival rates are accurate both in the overall and HPV-restricted cohort. Gunduz et al. astutely point out that the AJCC 8th edition has new staging changes for oropharyngeal cancers, particularly for HPV + tumors. In our initial publication, we utilized AJCC 6th/7th edition staging because we lack HPV data for the entire cohort and wanted to maintain consistency throughout the analysis. However, acknowledging these limitations, we have reclassified the patients with HPV data available (n = 6,872) using AJCC 8th edition staging. Among the HPV-negative patients (n = 1,835), there were no changes to the staging. Among the HPV + patients, 1,015 were classified as stage III per AJCC 6th/7th edition, of which 729 were re-classified to stage I and 286 were re-classified to stage II per AJCC 8th edition. Per AJCC 6th/7th edition, 4,022 patients were classified as stage IV. Of those, 3,374 were re-classified to stage II and 648 were re-classified to stage III per AJCC 8th edition. Table I presents the univariate and multivariate analysis by treatment, stratified by HPV status and AJCC staging separately. Table II presents the univariate and multivariate analysis by treatment, stratified by both stage and HPV status. Per the analysis, primary surgery with aRT ± CT continues to portend a survival advantage among both stage III/IV patients per the AJCC 6th/7th and 8th editions (Table I). The benefit of primary surgery with aRT ± CT is not seen among HPV + patients regardless of stage (Table II). In summary, when evaluating overall survival outcomes between primary surgery versus primary radiation treatments for oropharyngeal cancers in the context of AJCC 8th edition using the NCDB, primary surgery with aRT ± CT continues to demonstrate an overall survival benefit among HPV-negative patients, whereas the benefit among HPV + patients was attenuated.