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

• 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

 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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Head and neck cancer clinical practice guidelines version 2.2013

Lung cancer screening clinical practice guidelines version 1.2014

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