Cancer Res Treat.  2021 Oct;53(4):1004-1014. 10.4143/crt.2020.973.

Recent Treatment Patterns of Oropharyngeal Cancer in Korea Based on the Expert Questionnaire Survey of the Korean Society for Head and Neck Oncology (KSHNO)

• Choi KH
• Song JH
• Kim YS
• Kim Jh
• Jeong WJ
• Nam IC
• Kim JH
• Ahn HK
• Chun SH
• Hong HJ
• Joo YH
• Eun YG
• Moon SH
• Lee J

• KMID: 2521576
• DOI: http://doi.org/10.4143/crt.2020.973

Abstract

Purpose
The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea.
Materials and Methods
Five OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals.
Results
Sixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPV-positive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001).
Conclusion
In this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice patterns by stage and HPV status showed differences according to expert specialty. Multidisciplinary consensus guidelines will be essential in the future.

Keyword

Oropharyngeal neoploasms; Treatment patterns; Human papillomavirus; Questionnaire study

Figure

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  Fig. 1 Maximum intensity projection images of PET and clinical stage for five scenarios. AJCC, American Joint Committee on Cancer; HPV(+), human papillomavirus positive; HPV(−), human papillomavirus negative; PET, positron-emission tomography; PPY, pack-per-year.

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  Fig. 2 Graphs for the proportion of responses according to the experts’ specialty in five scenarios (A–E, cases 1–5). The numbers in the stacked bar chart indicate each percentage of respondents who chose the treatment modality. CCRT, concurrent chemoradiotherapy; CTx, chemotherapy; HPV(+), human papillomavirus positive; HPV(−), human papillomavirus negative; RT, radiotherapy.

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  Fig. 3 Graphs for the proportion of responses according to HPV status. CCRT, concurrent chemoradiotherapy; CTx, chemotherapy; HPV, human papillomavirus.

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  Fig. 4 Graphs for the proportion of responses according to nodal stage. CCRT, concurrent chemoradiotherapy; CTx, chemotherapy.

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  Fig. 5 Graphs for the proportion of responses according to hospital beds: T2N1M0 cases (A) and T2N2bM0 or T2N3M0 cases (B). CCRT, concurrent chemoradiotherapy; CTx, chemotherapy.

Reference

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