Evidence map›Paper›PMID 40934671›Full record

ArticleOral oncology2025

Incidence and outcomes of radiation-associated second primary malignancies in HPV-positive oropharyngeal cancer: long-term follow-up of the quarterback de-escalation trials.

J T Lovett, W H Westra, S Roof, R L Bakst, K Sindhu, E Genden, M T Wotman, T Ivic-Pavlicic, S Ahn, T Chen and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Oral oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

J T LovettDepartment of Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA. Electronic address: Jessica.Lovett@nyulangone.org.
W H WestraDepartment of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA.
S RoofDepartment of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
R L BakstDepartment of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
K SindhuDepartment of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
E GendenDepartment of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
M T WotmanDivision of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
T Ivic-PavlicicInstitute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
S AhnDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
T ChenIcahn School of Medicine at Mount Sinai, New York, NY, USA.
K MisiukiewiczIcahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
M PosnerTampa General Hospital Cancer Institute/Cancer Center of South Florida, Tampa, FL, USA.

Funding

THE TISCH CANCER INSTITUTE - CANCER CENTER SUPPORT GRANTP30CA196521 · NCI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI Ramon E Parsons · 2015 to 2026
$35.4M
NCI NIH HHS P30 CA196521
6 · The paper itself

Abstract

backgroundPatients with HPV oropharyngeal cancer will live for decades with the sequelae of therapy, including radiation induced second primary cancers (SP). This study reviews and reports the incidence and outcomes of in-field SPs from the Quarterback Trials (QT) where molecular testing confirmed HPV status at diagnosis and recurrence.

methodsPatients in the QT had <20 pack-year smoking history, locally advanced disease, and molecularly confirmed HPV status. All patients received TPF induction chemotherapy (IC). Responders were treated on protocol with reduced-dose (RD, 5600 cGy) or standard-dose (SD, 7000 cGy) chemoradiotherapy (CRT). Recurrences and SPs were confirmed by biopsy and molecular testing.

resultsOf the 60 eligible patients consented, 13 received SD (8 randomized to SD, 4 with inadequate response to IC, 1 withdrew consent). There were 7 HPV+ LRFs (1 SD, 6 RD) and 4 molecularly confirmed in-field non-HPV SPs (2 SD, 2 RD). All SP tumors were p53-mutated and HPV-negative. Median time to LRF and SP was 8 and 66 months, respectively. Median survival after LRF or SP was 11 months and 18+ months, respectively.

conclusionsNon-HPV SPs are not uncommon in HPV+ non-smoking patients and occurred more frequently with SD treatment, suggesting a radiation dose-dependent effect. SPs presented symptomatically. SPs are likely to become a major cause of mortality in this population over time, underscoring the need for molecular testing to guide surveillance and treatment decisions. This is especially relevant for analysis of outcomes in de-escalation trials.

Indexed as

Neoplasms, Second PrimaryOropharyngeal NeoplasmsPapillomavirus InfectionsAdultAgedChemoradiotherapyFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedChemoradiotherapyDe-escalationHuman papillomavirusMolecular testingOropharyngeal cancerRecurrenceSecond primary malignancy

Identifiers

PMID40934671
PMCPMC12578571

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.