A new face of the HPV epidemic: Oropharyngeal cancer in the elderly. (October 2020)

• Record Type: Journal Article
• Authors: Dickstein, Daniel R.; Egerman, Marc A.; Bui, Anthony H.; Doucette, John T.; Sharma, Sonam; Liu, Jerry; Gupta, Vishal; Miles, Brett A.; Genden, Eric; Westra, William H.; Misiukiewicz, Krzysztof; Posner, Marshall R.; Bakst, Richard L.
• Is Part Of: Oral oncology. Volume 109(2020)
• Publication Date: 2020-10
• Subjects: CCI Charlson Comorbidity Index -- DSS Disease Specific Survival -- ECOG Eastern Cooperative Oncology Group -- HPV Human Papillomavirus -- HPV− Human Papillomavirus negative -- HPV+ Human Papillomavirus positive -- LRC Locoregional Control -- OPSCC Oropharyngeal squamous cell carcinoma -- OS Overall Survival; Comorbidity -- Elderly -- Head and neck cancer -- Human papillomavirus (HPV) -- Radiotherapy -- Oropharynx -- Oropharyngeal squamous cell carcinoma (OPSCC); Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.104687
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: The rate of HPV-positive OPSCC in the elderly is increasing. Majority of oropharynx patients aged at least 70 are HPV positive. HPV status prognosticates clinical outcomes in the elderly. Elderly patients with OPSCC tolerate treatment well. Elderly patients with HPV OPSCC necessitate clinical trial enrollment. Abstract: Objectives: As the human papillomavirus (HPV) epidemic continues to grow, the number of elderly patients with oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing. Despite this observation, this cohort remains understudied. We aimed to understand HPV prevalence and characteristics within this cohort as well as its impact on disease control in elderly patients. Methods and Materials: We identified patients aged ≥70 with newly diagnosed, non-metastatic, OPSCC treated with curative intent at our institution from 2007 to 2018. Logistic regression and survival analyses were used for outcome-specific endpoints. Results: In total, 88 patients were identified with a median age of 73 (interquartile range [IQR]: 71–78) and a median Charlson Comorbidity Index of 6 (IQR: 5–7). Eighty-two percent were ECOG 0 or 1 performance. Of note, 70% of the cohort had HPV+ tumors. Fifty-one percent of patients were AJCC 8th edition stage I/II and 49% were stage III/IV. Median follow-up time was 2.5 years (IQR: 0.9–4.7). Eight percent had surgery alone, 27% underwent adjuvant RT, and 64% received definitive RT. Sixty-four percent received concurrent chemotherapy. By both univariate and multivariable analyses, HPV+ status was significantly associated with improved locoregional control (LRC), overall survival (OS), and disease specific survival (DSS). Conclusions: In our cohort of elderly patients with OPSCC, the majority was HPV+, which was associated with improved clinical outcomes. There are many challenges when managing elderly patients with OPSCC, but as the population ages and the HPV epidemic evolves, these patients should be considered for elderly specific clinical trials.