Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate‐risk features

Abstract

Background Survival outcomes for adjuvant chemoradiotherapy (aCRT) and adjuvant radiotherapy (aRT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate‐risk features. Methods We identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate‐risk feature: pT3‐T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of aCRT use and covariables impacting overall survival. Results aCRT was commonly used for both human papillomavirus (HPV)‐positive (62.0%) and HPV‐negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted aCRT utilization. There was no significant survival benefit associated with aCRT vs aRT in HPV‐positive (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.62‐1.38; P = .71) or HPV‐negative (HR, 0.75; 95% CI, 0.51‐1.10; P = .15) disease. Conclusions Despite high rates of utilization, aCRT is not associated with better survival vs aRT for OPSCC with intermediate‐risk features, including HPV‐negative tumors.

Treatment de‐escalation for HPV+ oropharyngeal cancer: A systematic review and meta‐analysis

“…Literature search led to a collection of 55 studies 6–8,10–61 (from 1393 screened references) for quantitative synthesis for a total of 38 929 patients (Figure S1). See Table 1 for characteristics of included studies.…”

Association of adjuvant radiation and survival in human papilloma virus‐positive oropharynx squamous cell carcinoma with lymphovascular invasion as the sole adverse pathologic feature

“…Gopalakrishna et al found in their study of 201 patients that LVI, extracapsular spread, and margin status were not predictive of 5‐year OS, disease‐specific survival, or recurrence‐free survival in univariate analysis for patients with HPV+ OPSCC, in contrast to their HPV− OPSCC counterparts 2 . Similarly, Goel et al found that while higher pT classification (pT3‐4) was associated with worse OS in both HPV+ and HPV− OPSCC, other traditional adverse features including LVI or multiple positive nodes were only associated with worse OS in HPV− OPSCC 19 …”

“…2 Similarly, Goel et al found that while higher pT classification (pT3-4) was associated with worse OS in both HPV+ and HPVÀ OPSCC, other traditional adverse features including LVI or multiple positive nodes were only associated with worse OS in HPVÀ OPSCC. 19 Multiple clinical trials have sought to determine which patients with HPV+ OPSCC are candidates for 8 Several studies are ongoing, including the PATHOS phase III trial and others, to further risk-stratify HPV+ patients for deescalation of adjuvant therapy. 21 As these randomized controlled trials mature, our understanding of optimal radiation dose (or administering radiation at all) for oncologic safety and minimal morbidity will continue to develop.…”