Chemoradiation for human papillomavirus positive oropharyngeal cancer in smokers: A single-institutional experience

Purpose

To determine how smoking intensity impacts the prognosis of patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated by chemoradiation.

Methods and materials

The medical records of 32 patients with histologically proven squamous cell carcinoma of the oropharynx and a prior smoking history were retrospectively reviewed. All patients were treated with intensity-modulated radiotherapy to a median dose of 70 Gy (range 63 to 72 Gy) with concurrent cisplatin. Seventeen patients (53 %) had stage II disease; and 15 patients (47 %) had stage III disease. Distribution of T-classification was: T1 8 (25 %); T2 4 (13 %); T3 10 (31 %); and T4 10 (31 %). Smoking history was categorized as follows: ≤10 pack-years (10 patients); 10–20 pack-years (6 patients); 20–30 pack-years (7 patients); >30 pack-years (9 patients).

Results

With a median follow-up of 40 months (range, 6 to 121 months), the 3-year overall survival for the entire population was 79 %. Significant differences in 3-year overall survival (83 % vs 54 %, p = 0.01), local-regional control (86 % vs 62 %, p < 0.001), and progression-free survival (75 % vs 52 %, p = 0.02) were observed when comparing patients with ≤30 pack-year versus those with >30 pack-year smoking histories.

Conclusion

The deleterious effect of smoking seemed to be most impactful in those with heavy consumption (i.e., >30 pack-year history).