Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy

Waleed Fouad Mourad, Kenneth S. Hu, Daniel Shasha, Catherine Concert, Dan Ishihara, Wilson Lin, Mauricio E. Gamez, John J. Lukens, Rania A. Shourbaji, Magdalena Ryniak, Zujun Li, Bruce E. Culliney, Azita S. Khorsandi, Theresa Tran, Adam Jacobson, Spiros Manolidis, Stimson Schantz, Mark Urken, Mark S. Persky, Louis B. Harrison

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Abstract

Aim: To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Patients and Methods: This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22%, 27% and 51%, respectively. Primary cancer sites comprised the larynx (37%), oropharynx (32%), oral cavity (13%), hypopharynx (7%), nasopharynx (4%), unknown primary (MUP) (4%), nasal cavity (3%), and submandibular salivary duct (1%). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70%) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17%) underwent neck dissection for N3 disease. Results: After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69% and 55% respectively. Seven patients (10%) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76% and 70%, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74%, 15% and 11% of patients, respectively. Hoarseness (grade 1) was reported in 10% of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77% and 23% of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10%) and absence of second malignancy. Conclusion: Definitive RT +/- chemotherapy for HIVseropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.

Original languageEnglish (US)
Pages (from-to)5511-5516
Number of pages6
JournalAnticancer research
Volume33
Issue number12
StatePublished - Dec 1 2013

Fingerprint

Radiotherapy
HIV
Drug Therapy
Salivary Ducts
Oropharynx
Carcinoma, squamous cell of head and neck
Larynx
Survival
Neck
Therapeutics
Xerostomia
Hoarseness
Hypopharynx
Neck Dissection
Nasopharynx
Second Primary Neoplasms
Nasal Cavity
Chi-Square Distribution
CD4 Lymphocyte Count
Deglutition Disorders

Keywords

  • CD4
  • Chemotherapy
  • Concurrent chemoradiotherapy
  • HIV
  • Head and neck cancer
  • IMRT
  • Radiation therapy
  • Squamous cell carcinoma
  • Viral load

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mourad, W. F., Hu, K. S., Shasha, D., Concert, C., Ishihara, D., Lin, W., ... Harrison, L. B. (2013). Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy. Anticancer research, 33(12), 5511-5516.

Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy. / Mourad, Waleed Fouad; Hu, Kenneth S.; Shasha, Daniel; Concert, Catherine; Ishihara, Dan; Lin, Wilson; Gamez, Mauricio E.; Lukens, John J.; Shourbaji, Rania A.; Ryniak, Magdalena; Li, Zujun; Culliney, Bruce E.; Khorsandi, Azita S.; Tran, Theresa; Jacobson, Adam; Manolidis, Spiros; Schantz, Stimson; Urken, Mark; Persky, Mark S.; Harrison, Louis B.

In: Anticancer research, Vol. 33, No. 12, 01.12.2013, p. 5511-5516.

Research output: Contribution to journalArticle

Mourad, WF, Hu, KS, Shasha, D, Concert, C, Ishihara, D, Lin, W, Gamez, ME, Lukens, JJ, Shourbaji, RA, Ryniak, M, Li, Z, Culliney, BE, Khorsandi, AS, Tran, T, Jacobson, A, Manolidis, S, Schantz, S, Urken, M, Persky, MS & Harrison, LB 2013, 'Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy', Anticancer research, vol. 33, no. 12, pp. 5511-5516.
Mourad, Waleed Fouad ; Hu, Kenneth S. ; Shasha, Daniel ; Concert, Catherine ; Ishihara, Dan ; Lin, Wilson ; Gamez, Mauricio E. ; Lukens, John J. ; Shourbaji, Rania A. ; Ryniak, Magdalena ; Li, Zujun ; Culliney, Bruce E. ; Khorsandi, Azita S. ; Tran, Theresa ; Jacobson, Adam ; Manolidis, Spiros ; Schantz, Stimson ; Urken, Mark ; Persky, Mark S. ; Harrison, Louis B. / Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy. In: Anticancer research. 2013 ; Vol. 33, No. 12. pp. 5511-5516.
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abstract = "Aim: To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Patients and Methods: This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22{\%}, 27{\%} and 51{\%}, respectively. Primary cancer sites comprised the larynx (37{\%}), oropharynx (32{\%}), oral cavity (13{\%}), hypopharynx (7{\%}), nasopharynx (4{\%}), unknown primary (MUP) (4{\%}), nasal cavity (3{\%}), and submandibular salivary duct (1{\%}). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70{\%}) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17{\%}) underwent neck dissection for N3 disease. Results: After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69{\%} and 55{\%} respectively. Seven patients (10{\%}) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76{\%} and 70{\%}, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74{\%}, 15{\%} and 11{\%} of patients, respectively. Hoarseness (grade 1) was reported in 10{\%} of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77{\%} and 23{\%} of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10{\%}) and absence of second malignancy. Conclusion: Definitive RT +/- chemotherapy for HIVseropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.",
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TY - JOUR

T1 - Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy

AU - Mourad, Waleed Fouad

AU - Hu, Kenneth S.

AU - Shasha, Daniel

AU - Concert, Catherine

AU - Ishihara, Dan

AU - Lin, Wilson

AU - Gamez, Mauricio E.

AU - Lukens, John J.

AU - Shourbaji, Rania A.

AU - Ryniak, Magdalena

AU - Li, Zujun

AU - Culliney, Bruce E.

AU - Khorsandi, Azita S.

AU - Tran, Theresa

AU - Jacobson, Adam

AU - Manolidis, Spiros

AU - Schantz, Stimson

AU - Urken, Mark

AU - Persky, Mark S.

AU - Harrison, Louis B.

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Aim: To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Patients and Methods: This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22%, 27% and 51%, respectively. Primary cancer sites comprised the larynx (37%), oropharynx (32%), oral cavity (13%), hypopharynx (7%), nasopharynx (4%), unknown primary (MUP) (4%), nasal cavity (3%), and submandibular salivary duct (1%). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70%) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17%) underwent neck dissection for N3 disease. Results: After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69% and 55% respectively. Seven patients (10%) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76% and 70%, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74%, 15% and 11% of patients, respectively. Hoarseness (grade 1) was reported in 10% of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77% and 23% of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10%) and absence of second malignancy. Conclusion: Definitive RT +/- chemotherapy for HIVseropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.

AB - Aim: To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Patients and Methods: This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22%, 27% and 51%, respectively. Primary cancer sites comprised the larynx (37%), oropharynx (32%), oral cavity (13%), hypopharynx (7%), nasopharynx (4%), unknown primary (MUP) (4%), nasal cavity (3%), and submandibular salivary duct (1%). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70%) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17%) underwent neck dissection for N3 disease. Results: After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69% and 55% respectively. Seven patients (10%) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76% and 70%, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74%, 15% and 11% of patients, respectively. Hoarseness (grade 1) was reported in 10% of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77% and 23% of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10%) and absence of second malignancy. Conclusion: Definitive RT +/- chemotherapy for HIVseropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.

KW - CD4

KW - Chemotherapy

KW - Concurrent chemoradiotherapy

KW - HIV

KW - Head and neck cancer

KW - IMRT

KW - Radiation therapy

KW - Squamous cell carcinoma

KW - Viral load

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