For some throat cancer patients, neck surgery may not be needed

A doctor at Fox Chase Cancer Center recently presented his findings.

A study conducted by researchers from Temple’s Fox Chase Cancer Center found that patients with HPV-positive cancer in the oropharynx, a part of the throat, are easier to treat than those with cancer in the organ not caused by HPV.

Findings were presented at the American Society for Radiation Oncology’s 56th Annual Meeting on Sept. 17.

Dr. Thomas Galloway, the attending physician and director of Clinical Research at FCCC, became the lead author of the study, and further investigated how many patients received neck surgeries after being treated for throat cancer, and whether or not these surgeries were necessary.

“What my study showed was that … HPV was the most significant prognostic variable for patients with oropharynx cancer,” Galloway said. “When you develop cancer from it, it seems to be very curable. It’s interesting, we do much better treating it than we do treating traditional oropharynx cancer.”

The study was a second analysis of a larger national trial, called RTOG129, conducted between 2002 and 2005, which sought various ways to treat head and neck cancers.

“What I did was analysis of something that wasn’t analyzed in the primary endpoint,” Galloway said. He said he wanted to answer the question, “How many of the patients after the treatment received neck surgery?”

During analysis, Galloway and his colleagues reviewed the medical records of throat cancer patients. Head and neck cancer patients who have swollen lymph nodes are often treated with radiation therapy and chemotherapy for between six and seven weeks, rather than undergoing extensive surgery.

If a lymph node persists in swelling after treatment, a patient can undergo a neck dissection surgery to have the “lump” removed.  Following radiation and chemotherapy treatments, only one-third of these patients underwent neck surgery to remove any persistent lumps.

“The reason we want to limit surgeries is because we know that, of those surgeries we perform, the bump that is there is actually dead to cancer,” Galloway said.

HPV, a virus known for causing cervical cancer in females, is increasingly listed as the cause of throat cancers, which in the past were often associated with excessive use of alcohol and tobacco. According to the Center for Disease Control and Prevention, about 70 percent of throat cancers were linked to HPV. Consequently, the study demonstrated higher levels of pathological complete response in patients with HPV-associated oropharyngeal cancers.

Although studies are emerging that link the significance of the presence of HPV in patients with oropharyngeal cancers, HPV infection is not currently a factor when making the decision on whether or not to proceed with a neck surgery. Since this study demonstrated HPV as a factor, which contributes to the effectiveness of treatment, Galloway hopes this finding, followed by future studies, will lead to fewer unnecessary neck surgeries. In addition, he hopes to one day provide less toxic treatments when treating and curing patients with HPV-associated oropharyngeal cancers.

“If you’re curing most patients relatively well, we ask ourselves, ‘Are we treating it too much?’” Galloway said. “‘Could we still be curing it 100 percent with giving it 15 percent less dosages?’ If you get less, your side effects are less. The worry is side effects, but we still have to cure the cancer.”

Galloway also revealed that FCCC has already opened trials examining less toxic and extensive ways to treat these forms of cancer, which include surgery and “de-intensified radiation.”

Kayla Oatneal can be reached at

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