Effect of XXXX on Patterns of Distant Metastatic Failure in @entity957 Treated With Chemoradiotherapy.

@entity1 @entity66 @entity5 @entity957 @entity1082 @entity3 @entity213
Importance: Important differences exist in the pattern and timing of distant @entity3 between @entity1082 -initiated (HPV+) and HPV- @entity957 ( @entity957 ). However, our understanding of the natural history of distant @entity3 in HPV+ @entity957 and its implications for surveillance is limited. Objective: To investigate the rate, pattern, and timing of distant @entity3 in advanced-stage @entity957 treated definitively with concomitant chemoradiotherapy. Design, Setting, and @entity1 : In a retrospective review, we identified 291 @entity1 with pathologically diagnosed stages III to IVB @entity957 and known HPV status from a @entity5 registry at the Cleveland Clinic. @entity1 were treated from January 1, 1996, through December 31, 2013. Details of treatment failure and the natural history of the disease were retrieved from the electronic medical records. Interventions: All @entity1 were treated with definitive concomitant chemoradiotherapy. Main Outcomes and Measures: The primary outcome was the rate and timing of distant @entity3 . Secondary outcomes included the pattern of distant failure and survival after distant @entity3 . Results: Thirty-seven @entity1 developed distant @entity3 after definitive treatment, including 28 of 252 @entity1 with HPV+ disease and 9 of 39 @entity1 with @entity66 . The 3-year projected distant control rate was higher in the HPV+ group (88% vs 74%; P   =   .01). The median time to develop distant @entity3 was also longer after the completion of treatment for HPV+ disease compared with @entity66 (16.4 vs 7.2 months; P   =   .008). We detected a trend in @entity1 with HPV+ disease for more distant metastatic sites involved than in those with @entity66 (2.04 vs 1.33 sites; P   =   .09). Although the lung was the most common distant site involved in HPV+ and @entity66 (HPV+ group, 23 of 28 @entity1 [82%]; HPV- group, 7 of 9 @entity1 [78%]), the HPV+ group had @entity3 to several subsets atypical for @entity213 , including the brain, kidney, skin, skeletal muscle, and axillary lymph nodes in 2 @entity1 each and in the intra-abdominal lymph nodes in 3 @entity1 . The rate of 3-year overall survival was higher in the HPV+ group (89.9% vs 62.0%; P   <   .001), as was the median survival after the occurrence of distant @entity3 regardless of additional treatment (25.6 vs 11.1 months; P   <   .001). Conclusions and Relevance: This retrospective review suggests that distant @entity3 in @entity1 with HPV+ @entity957 occurs significantly later after completion of chemoradiotherapy than in @entity1 with @entity66 . @entity1082 -initiated @entity957 also appears to involve a greater number of subsites and metastatic sites infrequently seen in @entity213 . Distant @entity3 in HPV+ @entity957 has unique characteristics and a natural history that may require alternative surveillance strategies.
