Primary surgery versus chemoradiotherapy for advanced oropharyngeal cancers: A longitudinal population study

Abstract

BackgroundTreatment for advanced stage oropharyngeal squamous cell carcinoma (OPSCC) includes combined chemoradiation therapy or surgery followed by radiation therapy alone or in combination with chemotherapy. The goal of this study was to utilize available evidence to examine survival outcome differences in patients with advanced stage OPSCC treated with these different modalities.MethodsPatients with advanced stage OPSCC were identified. Primary outcome measurements were disease specific and overall survival rates with differences examined via Kaplan-Meier and logistic regression analysis.Results344 patients were enrolled. 94 patients underwent triple modality therapy inclusive of surgery followed by adjuvant combined chemotherapy and radiation therapy (S-CRT). 131 had surgery and radiation therapy (S-RT), while 56 had chemoradiation (CRT) therapy as their primary treatment. A total of 63 patients had single modality radiation therapy and were excluded from analysis due to the large number of palliative patients.Kaplan-Meier overall survival analysis showed that therapy with S-CRT had the highest disease specific survival at five years (71.1%). This is contrasted against S-RT and CRT, with five year survival rates at 53.9%, and 48.6%, respectively.Cox regression showed that the comparison of S-CRT vs. S-RT, and CRT is associated with statistically significant increased hazard ratios of 1.974, and 2.785, indicating that both S-RT and CRT are associated with a reduced likelihood of survival at 5 years when compared to S-CRT.ConclusionsIn this population based cohort study S-CRT is associated with a 17–22% 5 year disease specific survival benefit compared to CRT or S-RT.

Association between polymorphisms in genes related to DNA base-excision repair with risk and prognosis of oropharyngeal squamous cell carcinoma

“…Patients with tumors at stage IV treated with chemoradiotherapy presented poor survival in our study, as previously reported (O'Connell et al 2013). In addition, we observed, for the first time, that OPSCC patients with tumors at stage IV and OGG1 c.977CC wild-type genotype had worst PFS when compared with carriers of variant allele.…”

Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy

“…In comparison to our centre’s previously published results, we found that the percentage of patients undergoing RT alone was not as high (18.3% in previous results vs 3% in this cohort) [2]. This likely reflects the fact that patients receiving RT alone was likely palliative, and these patients should have been removed from the previous study.…”

Role of primary surgery in the treatment of advanced oropharyngeal cancer

“…Some studies have shown equivalent outcomes, 5 whereas others clearly demonstrate superior survival with primary surgical approaches. 16,17 There have also been some retrospective historical 18 and case control 19,20 studies showing similar survival outcomes from these approaches. Moreover, preliminary results of transoral approaches are showing survival data comparable to that of primary CRT protocols.…”