Many throat cancer patients can skip neck surgery

Study shows that among those whose cancer was triggered by a virus, any lingering bumps after chemotherapy and radiation tend to be benign

A new study shows that patients with human papillomavirus (HPV) - the same virus associated with both cervical and head and neck cancer - positive oropharyngeal cancer see significantly higher rates of complete response on a post-radiation neck dissection than those with HPV-negative oropharyngeal cancer. Fox Chase Cancer Center researchers presented the findings at the American Society for Radiation Oncology's 56th Annual Meeting on Wednesday, September 17.

"For patients that achieve a complete response, neck surgery is probably unnecessary," says Thomas J. Galloway, MD, Attending Physician and Director of Clinical Research at Fox Chase and lead author on the study.

After radiation and chemotherapy to remove tumors from the tonsils or back of the tongue, many head and neck cancer patients still have persistent lumps in their neck, albeit perhaps smaller than when they were first diagnosed. "The question is: Do we need to remove those lumps, as well, or can we just let them dissolve on their own?" asks Dr. Galloway.

To investigate, he and his colleagues reviewed the medical records from 396 patients whose oropharyngeal tumors had spread to at least one lymph node. Within 180 days after completing radiation therapy, 146 patients underwent neck surgery. For 99 patients, their records indicated whether or not their tumors had likely been triggered by HPV.

Interestingly, patients with HPV often respond better to treatment for their oropharyngeal tumors than those without. The researchers noted the same trend here - people who tested positive for HPV (measured by the presence of a protein called p16) were less likely to have a recurrence of their cancers, regardless of whether or not the tumors had completely disappeared following treatment. Indeed, patients' HPV status was the strongest predictor of whether or not they were alive at the end of the study.

Among the patients who underwent neck surgery, any lingering bumps were more likely to be benign if patients were infected with HPV. "The bump might have become a permanent scar, or in some cases, it would have eventually disappeared," says Dr. Galloway.

Currently, it is not routine to consider a patients' HPV status before making the decision to perform neck surgery (the decision is based on physical examination and imaging studies), which can cause problems in the shoulder and neck, including swallowing, says Dr. Galloway; these findings suggest they should. "There's good reason to avoid neck surgery if we can."

The study that Dr. Galloway presented was supported by both a Radiation Therapy Oncology Group and Community Clinical Oncology Program grant from the National Cancer Institute.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation's first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center's nursing program has received the Magnet status for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, visit Fox Chase's Web site at https://www.foxchase.org or call 1-888-FOX CHASE or (1-888-369-2427).