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  1. Poster # 1100:Temporal Regression of Cervical Lymph Node in N2-N3 Head and Neck Cancer Treated with Primary Radiotherapy  Chemotherapy: stratified by HPV statusS Huang, B O’Sullivan, W Xu, H Zhao, A Chen, K Chan, J Kim, A Bayley, D Goldstein, J Waldron The Princess Margaret Hospital / University of Toronto, Canada • Objective: • To compare neck response after radiotherapy (RT)  chemotherapy (RT/CRT) for N2-N3 HPV(+) vs. HPV(-) head & neck cancer (HNC): • Temporal regression of gross LN after RT/CRT: K-M Method • Initial radiological involution and ultimate nodal resolution • HPV(+) HNC: included 257 p16 positive oropharyngeal cancers (OPC) • HPV(-) HNC: included 60 p16 negative OPC, 107 laryngeal, and 69 hypopharyngeal cancers • Excluded 171 HPV status unascertained OPCs and 43 post-RT LN un-assessable cases

  2. Definition: • Initial radiological complete response (CR): • Involution of the initial gross LN to ≤1.0 cm in CT/MR 8~12 weeks after RT or CRT • Percentage of gross LN involution at 8-12 weeks after RT/CRT: • (1-size of radiological residual LN / size of initial gross LN) x 100% • Elective neck dissection (END) • Neck dissection performed ≤20 weeks following RT (by RTOG 1016 protocol) • Ultimate LN resolution: • Previous gross LN involute to <1.0 cm without adverse features All HPV+ OPC & HPV(-) HNC* (n=493) rN: nodal failure HPV(+): 257 HPV(-) : 236 HPV() • Assess at 8-12 weeks by CT/MRI • CR: all LN ≤1.0cm HPV(+) CR: 125 (49%) No-CR: 132 (51%) CR: 129 (55%) No-CR: 107 (45%) END 6 (5%) all (-) No-END 119 (95%) END 63 (48%) 17 (+) (27%) No-END 69 (52%) rN 6 (9%) END 5 (4%) 4 (-); 1 (+) No-END 124 (96%) END 25 (23%) 11 (+) (44%) No-END 82 (77%) rN 34 (41%) Huang et al.(#1100): Temporal regression of gross LN in HPV(+) vs. HPV(-) HNC • In the no-CR cohort: END was not possible in 17/69 HPV(+) and 35/82 HPV(-) patients

  3. In HPV(+) HNC, lymph node continued to involute to a greater extent beyond 24 weeks Gross LN Duration Huang et al.(#1100): Temporal regression of gross LN in HPV(+) vs. HPV(-) HNC • HPV(+): p16(+) oropharynx (OPC) • HPV(-): p16(-) oropharynx (n=60); larynx (n=107); hypopharynx (n=69)

  4. Huang et al.(#1100): Temporal regression of gross LN in HPV(+) vs. HPV(-) HNC Take home Message: • The temporal regression of initial gross LN following RT is different for HPV(+) vs. HPV(-) HNC • LN resolution in HPV(+) is a more prolonged process and more reliably achieved beyond 24 weeks • HPV status was not a predictor for initial radiological CR at 8-12 weeks following RT but was a strong predictor for ultimate LN resolution • Initial gross LN size is a predictor for both initial radiological CR & ultimate LN resolution • Neck response assessment protocols and management approaches may need modification for HPV(+) HNC in terms of timing, size criteria, and use of additional interventions such as END

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