Question About Treatment
I have just started treatment for Oropharyngeal Cancer tonsil stage 4. Radiation and chemotherapy. I have been doing some research alot of research and found this from the The New England Journal of Medicine.
http://www.nejm.org/doi/full/10.1056/NEJMoa0912217#t=articleResults
Please help me with the answer-it is very very troublesome.
The article lists three catagories. Low, medium and high risk of death. I am in the high risk of death as I have Stage 4 "locally advanced" just spread to lymph node, HPV- and former 10 pack year plus smoker. The article says a 3 year survival rate of 46.2%. "The 3-year rates of overall survival were 93.0% (95% CI, 88.3 to 97.7) in the low-risk group, 70.8% (95% CI, 60.7 to 80.8) in the intermediate-risk group, and 46.2% (95% CI, 34.7 to 57.7) in the high-risk group."
Same as the as the cancer.gov site. "The 3-year rates of overall survival (OS) were 93.0% (95% confidence interval [CI], 88.3–97.7) in the low-risk group, 70.8% (95% CI, 60.7–80.8) in the intermediate-risk group, and 46.2% (95% CI, 34.7–57.7) in the high-risk group.[12]"
http://www.cancer.gov/cancertopics/pdq/treatment/oropharyngeal/HealthProfessional
Cancer.gov quotes the The New England Journal of Medicine article, which also says in the very last paragraph in the article referring to my cancer which puts me in the high risk of death catagory "Unfortunately, patients in the high-risk group have an extremely poor prognosis and thus should be offered enrollment in trials testing more intensive investigational therapies.
Should I be offered or looking into trials. I have not been offered any. My doctor says I should only look at cancer.gov for information. I did and it gives me a 46.2% three year survival rate and a worse five year rate and the article referred to in cancer.gov says I have "extremely poor prognosis" and I should be offered a trial. My doctor says just the radiation and chemotherapy is best for me. How does I find a trial.
Comments
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Do what's best for you
I'm about to start the same treatment as you I have learned from the folks on here you have to be up beat and try to be the best patient you can be. I actually start my first Chemo and Rad tx tomorrow! Just gotta try not to look at the negatives and look at it as something you have to do the best you can. I hope you have good support in place as this helps a lot to just talk out your feelings and fears these sites have also helped me through my fears and axiouty try going to the chat room lot of good helpful people there. Il know what your feeling I have had those same thoughts as I am sure many on here have so know your not alone. Work with your team and help them with your treatments keep a log as this will help you with any questions you may have. Research is good but to much can scare the crap out of you,LOL
Hope this helps and all works out for you and remember no one is promised tomorrow so live today.
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I understand the statisticslornal said:Stage 4
A lot of people here have had stage 4 and survived. I don't know what all those statistics mean, but tonsil cancer, stage IV with affected lymph nodes - is quite surviable. Treatment is tough, but doable, even for us big wimps!
Lorna 2007 & 2014
I understand the statistics and what they mean they mean what they say a high risk of death and 46% three year survival rate and because of the hpv negative and tobacco I have a "very poor prognosis." It is just a statistic. They use statistics to determine types of treatment too. But what about the recommendation of trial they mean I should be looking into something besides the standard treatment.
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I don't care about fears andedreddog said:Do what's best for you
I'm about to start the same treatment as you I have learned from the folks on here you have to be up beat and try to be the best patient you can be. I actually start my first Chemo and Rad tx tomorrow! Just gotta try not to look at the negatives and look at it as something you have to do the best you can. I hope you have good support in place as this helps a lot to just talk out your feelings and fears these sites have also helped me through my fears and axiouty try going to the chat room lot of good helpful people there. Il know what your feeling I have had those same thoughts as I am sure many on here have so know your not alone. Work with your team and help them with your treatments keep a log as this will help you with any questions you may have. Research is good but to much can scare the crap out of you,LOL
Hope this helps and all works out for you and remember no one is promised tomorrow so live today.
I don't care about fears and anxiety. I don't care about the statistics. It is what it is. research says that I look into trials. My doctor only says do radiation and chemotherapy but tell me to only look at the cancer.gov website. I did and it says high rate of death and trials.
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clinical trials
Chen1911,
Welcome to the H&N forum I am sorry that you are getting off to a bad start.
I believe clinical trials are normally after the “tried and true” methods have been exhausted. I assume your cancer would have to be very advanced to have your team looking for answers elsewhere.
I was stage IVa, scc, bot, 1 lymph node, hpv+ and currently 100% still here, but if I perused those statistics as you have I would have seen less optimistic results.
Back to your question, If you ask enough doctors to say “you’re a candidate for clinical trial” I am sure you will get a taker.
Good luck,
matt
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My apologiies for bad start.CivilMatt said:clinical trials
Chen1911,
Welcome to the H&N forum I am sorry that you are getting off to a bad start.
I believe clinical trials are normally after the “tried and true” methods have been exhausted. I assume your cancer would have to be very advanced to have your team looking for answers elsewhere.
I was stage IVa, scc, bot, 1 lymph node, hpv+ and currently 100% still here, but if I perused those statistics as you have I would have seen less optimistic results.
Back to your question, If you ask enough doctors to say “you’re a candidate for clinical trial” I am sure you will get a taker.
Good luck,
matt
My apologiies for bad start. You are hpv+ with no tobacco you are low risk of death. I am hpv- with tobacco history. Cancer.gov site puts me in the high risk of death catagory. That is my prognosis. It is what it is. Anyone hpv- stage 4 10 pack years plus? If so, did your doctor talk about trial? Only applicable ot hpv- sfage 4 10 plus pack years.
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Welcome to the H&N group
First i'll say welcome and sorry you need to be here. Second I will say it's best not to go and google to much as you will get more wrong info then good info. Just before surgery I was T4;N2;M0 . my tumor was 3 cm x 2.5 cm and laying on my vocal cord. Be cause they thought it had gone to a lymph gland I was T4 and N2. If it involves a lymph gland you often get Stage 4. Long story short. I ended up T3;N0;M0 stage 3, SCC supraglottic. Smoked 550 packs a year for 42 years and a general 5 year survival of 60.6%. Well they removed all of the tumor and 86 lymph glands all clear but done as a percaution. My survival went up to over 70+%. Now I was not HPV, and have a 25% chance of it coming back. That means I have a 75% it wont come back. Of 200 people I worked with only two thought they would ever see me again. I never had chemo or and radiation. I went back to work in 10 weeks and they removed my larynx and I had to learn to swallow and talk but I did and went back to work and have been NED [ no evidence of disease] for 18 months and all the cancer is gone. Oh, I also have stage 3 COPD that is why they took my larnyx, because I would not survive the surgery because of my lungs.
You have very good odds and much better than I had. You just think positive and take one day at a time and KNOW you will beat it. You will beat this as so many of us have. I still have my damn tonsils, go figure. They just sat 5 years but that is only where they stop counting, and we go for many years past that. I'm 64 and feel great and will live for many years, unless a car hits me. You will be fine and get through this. Everyone will help and geve all the support you need.
Bill
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Thanks. My doctor confirmedwmc said:Welcome to the H&N group
First i'll say welcome and sorry you need to be here. Second I will say it's best not to go and google to much as you will get more wrong info then good info. Just before surgery I was T4;N2;M0 . my tumor was 3 cm x 2.5 cm and laying on my vocal cord. Be cause they thought it had gone to a lymph gland I was T4 and N2. If it involves a lymph gland you often get Stage 4. Long story short. I ended up T3;N0;M0 stage 3, SCC supraglottic. Smoked 550 packs a year for 42 years and a general 5 year survival of 60.6%. Well they removed all of the tumor and 86 lymph glands all clear but done as a percaution. My survival went up to over 70+%. Now I was not HPV, and have a 25% chance of it coming back. That means I have a 75% it wont come back. Of 200 people I worked with only two thought they would ever see me again. I never had chemo or and radiation. I went back to work in 10 weeks and they removed my larynx and I had to learn to swallow and talk but I did and went back to work and have been NED [ no evidence of disease] for 18 months and all the cancer is gone. Oh, I also have stage 3 COPD that is why they took my larnyx, because I would not survive the surgery because of my lungs.
You have very good odds and much better than I had. You just think positive and take one day at a time and KNOW you will beat it. You will beat this as so many of us have. I still have my damn tonsils, go figure. They just sat 5 years but that is only where they stop counting, and we go for many years past that. I'm 64 and feel great and will live for many years, unless a car hits me. You will be fine and get through this. Everyone will help and geve all the support you need.
Bill
Thanks. My doctor confirmed my prognosis from the cancer.gov website. SEER. You get sick you get a prognosis. 46 % 3 year survival. I know what it means. My prognosis is "high risk of death". It is a number. My doctor does not agree with you. It is what it is. Says to get through treatment do not smoke or drink eat right exercise. Positive thinking alternative diets has no effect on cancer according to the rssearch she says and she says the standard rad chem is want i should get.
She says General or Overall survival rates include hpv+ which adds 20 points more. I was told to look at how the cancer.gov site breaks it down and rely on their numbers. No question that I have a poor prognosis That is the reason for my question.
No one has answered my question. Apparently I offended someone by asking it. I will ask it again. Has anyone whose prognosis is in the "high risk of death" catagory hpv- stage 4 10 plus pack years been offerred a trial as recommended in The New England Journal of Medicine article?
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Percentages, Trials and You..
As Matt said, more than likely you won't be offered trials unless standard methods aren't producing the expected results.. Especially from your current MD..
If you seek other opinions, I'm sure you might find someone willing to put you in a trial, maybe not.
My question for you... are you more willing to participate in a trail that has not proven to be effective percentage wise, over proven methods...?
I don't think you've offended anyone, you just haven't received the specific answer that you are seeking from here...
Nobody here can give you or is qualified to tell you what is the best medical decision based upon your history.
Statistics are just that.., a large sample of individuals.., each bringing all kinds of backgrounds, locales, genetics, and like you, individual things that influence the results.., and statitistics.
But again, we all do.., you can only try to make the best decisions for you, and trust your MD's..
Your MD is wrong as for his comment on positive thinking... I can not agree on any level... I feel that it can effect your health, your healing, your longevity, and your individual statistics to survive.
Do you really think that having a negative attitude will have no effect on healing, responding to treatment and beating the disease, as one that has a positive attitude...?
I hope you find the answers you are seeking..I do not fall into the category that you are seeking either though.., I was STGIII HPV+ Tonsils... Clean and clear for over six years now..
Best
John
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Dont let statstics run your life
the nimbers are different for all who suffer. I was diagnosed in 2009 with stage 4 neck cancer. Removed my tonsil and part of my to gue. I did 7 weeks kemo and radiation. What i dont care about is all the **** your not told by your doctor.
Like your jaw bone and teeth fall apart. You have no salvatory glands due to radiation. I have to have 19 teeth removed today 5/4/15.
I hate docors and dentist as they are there for the money. A dentist did a root canal on me and put a cap knowing he wasnt suppose to. The tooth. Roke a week later cap came off and im in pain.
I have no idea what to do after today as im back to living 1 day at a time again But i will not let this run my life and noone should either. Kevin keane
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Run, don't walk
I will try not to be rude~~my advice to you is to go to a major cancer center in your state. I don't think any highly rated Dr, would encourage you, or support you in your findings,to say you have a certain amount time to live. When I read about my cancer, before, finding this site...statistics showed I had very little chance of surviving...I found CSN and stayed away from google. 3 and 1/2 years later, I am doing great..enjoying my life, eating whatever, babysitting my grandson and always on the go.
You keep saying, "it is what it is", yes, that's true..but, you need a specialist that will encourage you to fight the hard fight.
As for a trial, since there are many people that survived your type cancer, with treatment available..so I doubt if you're going to be offered one.
Good luck to you, it's a difficult journey, and I sincerely hope you have support along the way
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I learned early....like many others on here...
to stay away from Google (and the stats)...it scared me at a time when I was scared enough....plus I was afraid I wouldn't go into my fight with a winning attitude. I sure as hell wouldn't trust a government site for my information, either....for all you know it's as old as everything else the government takes care of (recorded by data entry people who are government workers who probably don't care about a typo or two). If you really feel a need to read stats, head for cancer center sites like Mayo, or MD Anderson....somewhere where they're more up to date.
As for trials....I've never heard of anybody going into a clinical trial on a first diagnosis....there are folks here who have gone into them at the second or third time of diagnosis. There are also an awful lot of people here diagnosed with Stage III and IV cancers who are still kicking around this site after 3 + years....I was a smoker for 40 years (quit 3 years before I was diagnosed)....drank alcohol for many years (quit 27 years before diagnosis).....and my Dr. told me that chances were high my cancer isn't what will kill me in the end. Stage III Nasopharyngel Carcinoma....with 2 bilateral nodes infected. I'm almost 3 years out, and feeling pretty darn good.
Hoping you find the answers you're looking for.....
p
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When I was first diagnosed,
When I was first diagnosed, I saw the same statistics on cancer.gov. In my case, (Stage 4a, BOT, spread to one node on each side of my neck, non-smoker, non-drinker, HPV negative) the stats looked grim. Most cases are HPV positive, so there is not a large study pool of those with negative status. People with a negative status also tend to be older which affects outcome. Treatment and prognosis has to be more individualized. I had radiation, no surgery, and cetuximab instead of a platinum based chemo drug. My doctor is very optimistic I'm cured. The treatment is tough, but a positive attitude, supportive people, and prayer do help. We all felt terrified when first hearing the diagnosis. The people on this board were here for me with good advice and support. As far as side effects of therapy, I had acupuncture and found it relieved nausea and sore throat, and preserved my salivary gland function and sense of taste. There have been improvements in the treatment of cancer since many of the reports on the Web were written. Find a doctor who is current and compassionate. You'll do better.
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My doctor is current andMrsBD said:When I was first diagnosed,
When I was first diagnosed, I saw the same statistics on cancer.gov. In my case, (Stage 4a, BOT, spread to one node on each side of my neck, non-smoker, non-drinker, HPV negative) the stats looked grim. Most cases are HPV positive, so there is not a large study pool of those with negative status. People with a negative status also tend to be older which affects outcome. Treatment and prognosis has to be more individualized. I had radiation, no surgery, and cetuximab instead of a platinum based chemo drug. My doctor is very optimistic I'm cured. The treatment is tough, but a positive attitude, supportive people, and prayer do help. We all felt terrified when first hearing the diagnosis. The people on this board were here for me with good advice and support. As far as side effects of therapy, I had acupuncture and found it relieved nausea and sore throat, and preserved my salivary gland function and sense of taste. There have been improvements in the treatment of cancer since many of the reports on the Web were written. Find a doctor who is current and compassionate. You'll do better.
My doctor is current and compassionate.
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I found the answer. Nophrannie51 said:I learned early....like many others on here...
to stay away from Google (and the stats)...it scared me at a time when I was scared enough....plus I was afraid I wouldn't go into my fight with a winning attitude. I sure as hell wouldn't trust a government site for my information, either....for all you know it's as old as everything else the government takes care of (recorded by data entry people who are government workers who probably don't care about a typo or two). If you really feel a need to read stats, head for cancer center sites like Mayo, or MD Anderson....somewhere where they're more up to date.
As for trials....I've never heard of anybody going into a clinical trial on a first diagnosis....there are folks here who have gone into them at the second or third time of diagnosis. There are also an awful lot of people here diagnosed with Stage III and IV cancers who are still kicking around this site after 3 + years....I was a smoker for 40 years (quit 3 years before I was diagnosed)....drank alcohol for many years (quit 27 years before diagnosis).....and my Dr. told me that chances were high my cancer isn't what will kill me in the end. Stage III Nasopharyngel Carcinoma....with 2 bilateral nodes infected. I'm almost 3 years out, and feeling pretty darn good.
Hoping you find the answers you're looking for.....
p
I found the answer. No promising trials otherwise they would offer them to those like me. HPV+ patients may see a change in standard treatment because of the research. I was told (this morning) maybe less radiation and such.
This is what I was told. As far as the statistics they are correct. Not from google. cancer.gov is very reliable info. The New England Journal of Medicine article is very very good. The research says if you are HPV+ and never smoked or below 10 pack years-very very good outcome even if stage 4. And the same for the other side HPV- Stage 4 10 pack years or more-extremely poor prognosis and no promising treatments trials on the horizon. Like Yul Brenner said in his commerical "don't smoke just don't smoke." 50% greater chance of reoccurance if you smoked. 100% greater chance of reoccurance if you still smoke after treatment. I was told complete treatment dont smoke or drink exercise eat right and cross your fingers. I can accept that.
I was told that unless one prys is told the overall or general statistic 66% or something like that in reality it is much much better if you are hpv+ and never smoked and much much worse if you are hpv- and smoked.
Like it or not those are the numbers.
Skiffen-positive attitude means nothing in the sense that research does not support it. I was told otherwise we would be pumped full of mood enhancing meds. Meditation and such doesnt stop tumor growth. You cant think your self healthy. Hypnosis doesnt work either. Clinically depressed patients will do as well as those who are not provided they complete treatment dont smoke or drink exercise and eat rigtht.
Had a good discussion this morning. This cancer is more than likely going to kill me, but maybe not. (I will jump off a roof if I have to drink another Ensure though). That is my prognosis.
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Opinions...Chen1911 said:I found the answer. No
I found the answer. No promising trials otherwise they would offer them to those like me. HPV+ patients may see a change in standard treatment because of the research. I was told (this morning) maybe less radiation and such.
This is what I was told. As far as the statistics they are correct. Not from google. cancer.gov is very reliable info. The New England Journal of Medicine article is very very good. The research says if you are HPV+ and never smoked or below 10 pack years-very very good outcome even if stage 4. And the same for the other side HPV- Stage 4 10 pack years or more-extremely poor prognosis and no promising treatments trials on the horizon. Like Yul Brenner said in his commerical "don't smoke just don't smoke." 50% greater chance of reoccurance if you smoked. 100% greater chance of reoccurance if you still smoke after treatment. I was told complete treatment dont smoke or drink exercise eat right and cross your fingers. I can accept that.
I was told that unless one prys is told the overall or general statistic 66% or something like that in reality it is much much better if you are hpv+ and never smoked and much much worse if you are hpv- and smoked.
Like it or not those are the numbers.
Skiffen-positive attitude means nothing in the sense that research does not support it. I was told otherwise we would be pumped full of mood enhancing meds. Meditation and such doesnt stop tumor growth. You cant think your self healthy. Hypnosis doesnt work either. Clinically depressed patients will do as well as those who are not provided they complete treatment dont smoke or drink exercise and eat rigtht.
Had a good discussion this morning. This cancer is more than likely going to kill me, but maybe not. (I will jump off a roof if I have to drink another Ensure though). That is my prognosis.
You are welcome to express yours...
I'm not really sure what you are seeking here... Everyone that offers their experence or opinions, you seem to want to debunk them.. You have already made your mind up on everything, so I can't really offer you anything further.
I wish you the best..
Positive thoughts and attitude is positive..., as is a negative one, ummm negative. Concerning your way of rational, I presume you don't feel offering prayer has any positive results either..?
Best
John
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HelloChen1911 said:I found the answer. No
I found the answer. No promising trials otherwise they would offer them to those like me. HPV+ patients may see a change in standard treatment because of the research. I was told (this morning) maybe less radiation and such.
This is what I was told. As far as the statistics they are correct. Not from google. cancer.gov is very reliable info. The New England Journal of Medicine article is very very good. The research says if you are HPV+ and never smoked or below 10 pack years-very very good outcome even if stage 4. And the same for the other side HPV- Stage 4 10 pack years or more-extremely poor prognosis and no promising treatments trials on the horizon. Like Yul Brenner said in his commerical "don't smoke just don't smoke." 50% greater chance of reoccurance if you smoked. 100% greater chance of reoccurance if you still smoke after treatment. I was told complete treatment dont smoke or drink exercise eat right and cross your fingers. I can accept that.
I was told that unless one prys is told the overall or general statistic 66% or something like that in reality it is much much better if you are hpv+ and never smoked and much much worse if you are hpv- and smoked.
Like it or not those are the numbers.
Skiffen-positive attitude means nothing in the sense that research does not support it. I was told otherwise we would be pumped full of mood enhancing meds. Meditation and such doesnt stop tumor growth. You cant think your self healthy. Hypnosis doesnt work either. Clinically depressed patients will do as well as those who are not provided they complete treatment dont smoke or drink exercise and eat rigtht.
Had a good discussion this morning. This cancer is more than likely going to kill me, but maybe not. (I will jump off a roof if I have to drink another Ensure though). That is my prognosis.
I can’t give you an advice, as I was/am having a different type of cancer (nasopharyngeal, stage III). But I would like to comment on the positive attitude. It actually matters, but it is very difficult to quantify. Here’s why I am saying it matters: the mood affects your immune system (proven). The immune system affects your cancer growth (proven at least with animal studies). There are currently immunotherapy clinical trials ongoing, but these are highly experimental, and I seriously doubt would be offered as a first line of treatment.
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Clinical trial info.Chen1911 said:My doctor is current and
My doctor is current and compassionate.
Hello All,
Rarely post but am doing well.
I recently completed a clinical trial using MEDI4736. This is an immunotherapy drug that allows the immune system to activate and destroy the cancel cells. Specifically, some tumors send out a signal (PDL1) that tricks the immune system to not activate to kill the cancer cells. Anti PDL1 blocks the signals sent by the tumors allowing the body activate it's immune system to attack the tumor. Not all tumors express PDL1 but my understanding is HPV + or - isn't a variable. It worked for me so I recommend everybody look into it. I had treatment at The Angeles Clinic in Los Angeles by Dr. Ani Balmanoukian. The clinic and Dr. Ani are awesome.
Link to clinical trial: https://clinicaltrials.gov/ct2/show/NCT01693562
Have faith and good luck!!
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DebunkSkiffin16 said:Opinions...
You are welcome to express yours...
I'm not really sure what you are seeking here... Everyone that offers their experence or opinions, you seem to want to debunk them.. You have already made your mind up on everything, so I can't really offer you anything further.
I wish you the best..
Positive thoughts and attitude is positive..., as is a negative one, ummm negative. Concerning your way of rational, I presume you don't feel offering prayer has any positive results either..?
Best
John
I posted on here when I was very frustrated. Everyone is HPV+, and the few who are not had the standardized treatment. I spoke this morning with someone very knowledgable about the research side of things and I was schooled.
The article that recommends trials for those like me was simply a comment on the dismal stats associated with this type of cancer when discovered at stage 4 HPV- and an extensive smoking history. A comment that we the prognosis is "extremely poor" and we should be looking for something new (as I was told).
I was also told that postive thoughts and attitude are good but have no effect on cancer tumors-they researched it. Topic came up with the issue of depression and being told true prognosis. I don't mean to downplay having a positive attitude as it affects everything especially continuing treatement exercise non drinking and smoking and eating healthy. Just that clinical depression (a really really poor atittude) does not effect the tumor growth.
I was told that many doctors are very conservative and instead of jumping up and down yelling happily we they find out you are HPV+ (if you were not a smoker) they give their patients a very conservative diagnosis. When it is really out of this world cancer-wise positive. Cure cure cure.
Likewise on the other side of things.
Debunk the responses. No. The responses were to pooh pooh the question. Dont read statistics. Dont google. I received responses that did not even touch on the question. I do have my answer now. Reading this forum it appears that HPV-cancer is now almost rare except for WMC who I believe from reading his posts it would take a thermal nuclear device to finish him.
Finally, an interesting thing. World renown head and neck cancer researcher (first name on the article) K. Kian Ang from the MD Anderson Cancer Center died of cancer-he was the first name on the article that says to use trials.
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MrsBd, my reading of yourMrsBD said:When I was first diagnosed,
When I was first diagnosed, I saw the same statistics on cancer.gov. In my case, (Stage 4a, BOT, spread to one node on each side of my neck, non-smoker, non-drinker, HPV negative) the stats looked grim. Most cases are HPV positive, so there is not a large study pool of those with negative status. People with a negative status also tend to be older which affects outcome. Treatment and prognosis has to be more individualized. I had radiation, no surgery, and cetuximab instead of a platinum based chemo drug. My doctor is very optimistic I'm cured. The treatment is tough, but a positive attitude, supportive people, and prayer do help. We all felt terrified when first hearing the diagnosis. The people on this board were here for me with good advice and support. As far as side effects of therapy, I had acupuncture and found it relieved nausea and sore throat, and preserved my salivary gland function and sense of taste. There have been improvements in the treatment of cancer since many of the reports on the Web were written. Find a doctor who is current and compassionate. You'll do better.
MrsBd, my reading of your prognosis is a 70% + 3 year survival rate. Intermediate risk group.
Right off the website. I hope for yours being a 100% survival rate.
http://www.cancer.gov/cancertopics/pdq/treatment/oropharyngeal/HealthProfessional/page1
The prognosis of oropharyngeal carcinoma is based on HPV status, smoking history (pack-year smoking history of 10 or more years), tumor stage, and nodal stage. The following criteria are used to determine whether patients have low-, intermediate-, or high-risk oropharyngeal carcinoma and have been defined using recursive partitioning analysis in a retrospective analysis of a randomized trial of stage III and IV oropharyngeal SCC patients treated with chemoradiation:
- Low-risk patients include those with HPV-positive tumors, a smoking history of 10 or fewer pack years, and N0 to N2a nodal disease.
- Intermediate-risk patients include those with HPV-positive tumors, a smoking history of more than 10 pack years, and N2b–N3 disease; or, for those with HPV-negative tumors, a smoking history of 10 or fewer pack years, N2b or N3 disease, or T2–3 tumors.
- High-risk patients include those with HPV-negative tumors and a smoking history of more than 10 pack years; or, for those with HPV-negative tumors, a smoking history of 10 or fewer pack years, and T4 disease.
The 3-year rates of overall survival (OS) were 93.0% (95% confidence interval [CI], 88.3–97.7) in the low-risk group, 70.8% (95% CI, 60.7–80.8) in the intermediate-risk group, and 46.2% (95% CI, 34.7–57.7) in the high-risk group.[12]
Citing:
http://www.nejm.org/doi/full/10.1056/NEJMoa0912217#t=article
WOW Stage 4 Cancer with a 93.0% 3 year survival (assuming no smoking history). All you HPV+ are in the money. All of us ex-smokers HPV- Stage 4 patients should get together and have a spend the retirement funds party (just kidding-gallows humor).
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