Clinical Outcomes of Head and Neck Cancer Patients Who Undergo Resection, But Forgo Adjuvant Therapy

Loganadane, Gokoulakrichenane; Kann, Benjamin H.; Park, Henry S.; Johnson, Skyler B.; Mehra, Saral; Judson, Benjamin L.; Bhatia, Aarti; Belkacémi, Yazid; Yarbrough, Wendell G.; Burtness, Barbara; Husain, Zain

doi:10.21873/anticanres.13674

Cited by 12 publications

(6 citation statements)

References 15 publications

(18 reference statements)

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“…The foundational trials underlying PORT recommendations did not definitively establish a survival benefit. 34,35 Although retrospective institutional data have also shown mixed results, 30,36 one large population-based study detected a nearly 10% survival improvement with PORT in all head and neck cancer types. 8 National Comprehensive Cancer Network (NCCN) guidelines currently recommend PORT for patients with HPV-associated OPSCC with advanced pathologic stage or high-risk pathological features.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

et al. 2021

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Objectives/Hypothesis: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct clinical entity with good prognosis, unique demographics, and a trend toward treatment deintensification. Patients with this disease may opt out of recommended postoperative radiation therapy (PORT) for a variety of reasons. The aim of this paper was to examine factors that predict patient refusal of recommended PORT in HPV-associated OPSCC, and the association of refusal with overall survival.Study Design: Retrospective population-based cohort study of patients in the National Cancer Database.Methods: We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with OPSCC between January 2010 and December 2015. We primarily assessed overall survival and the odds of refusing PORT based on demographic, socioeconomic, and clinical factors. Analysis was conducted using multivariable logistic regression and multivariable Cox proportional hazards model.Results: A total of 4229 patients were included in the final analysis, with 156 (3.7%) patients opting out of recommended PORT. On multivariable analysis, patient refusal of PORT was independently associated with a variety of socioeconomic factors such as race, insurance status, comorbidity, treatment at a single facility, and margin status. Lastly, PORT refusal was associated with significantly lower overall survival compared to receipt of recommended PORT (hazard ratio 1.69, confidence interval 1.02-2.82).Conclusions: Patient refusal of recommended PORT in HPV-associated OPSCC is rare and associated with variety of disease and socioeconomic factors. PORT refusal may decrease overall survival in this population. Our findings may help clinicians when counseling patients and identifying those who may be more likely to opt out of recommended adjuvant therapy.

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Section: Discussionmentioning

confidence: 99%

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

et al. 2021

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“…A further potential reason for refusing AT might be the fear of potential adverse effects, which has been reported in various investigations. 15 We suggest that the data from this study might help to guide decision-making in evaluating the advantages and disadvantages of AT. Previous studies reported low socioeconomic status, increased age, distance to treatment facility, and female sex as risk factors for refusal.…”

Section: Discussionmentioning

confidence: 88%

“…In this observational matched cohort study, we present data on 82 patients who either received or refused the recommended AT after primary resection of advanced OSCC. Although AT has been established in the treatment of oral cancer for over 30 years, there are only a few studies reporting outcome measures in patients withdrawing from AT . While these studies focused on human papillomavirus–associated OPSCC and HNSCC in general, there was until now, to our knowledge, no study reporting data from OSCC in particular.…”

Section: Discussionmentioning

confidence: 99%

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Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

Mrosk,

Doll,

Scheer

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceClinicians may be confronted with patients refusing recommended adjuvant therapy (AT) after the primary resection of an advanced oral squamous cell carcinoma (OSCC). However, for this tumor entity, data are lacking regarding the oncological outcomes and associated factors after refusal of AT.ObjectiveTo evaluate the difference in survival and disease recurrence for patients with and without recommended AT after resection of advanced OSCC.Design, Setting, and ParticipantsIn this single-center retrospective matched cohort study, patients with advanced OSCC who refused recommended AT between January 2010 and December 2021 were matched 1:1 according to Union for International Cancer Control tumor staging with patients who completed AT.ExposuresPatients with advanced OSCC who refused or completed recommended AT between 2010 and 2021.Main Outcomes and MeasuresThe primary outcome of this study was the comparison of overall survival (OS) and recurrence-free survival (RFS) between the 2 study groups.ResultsA total of 82 patients (mean [SD] age at time of surgery, 68.0 [11.3] years; 38 [46.3%] female, 44 [53.7%] male) with and without AT (41 per study group) were included in the analysis. Patients refusing AT developed more frequent disease recurrence than patients who completed AT (61.0% vs 26.8%; difference, 34.2%; odds ratio, 4.26; 95% CI, 1.68-10.84). In addition, patients who refused AT presented with lower 2-year OS (72.7% vs 88.6%; difference, 15.9%; 95% CI, 8.6%-40.6%) and much lower 2-year RFS (39.1% vs 74.2%; difference, 35.1%; 95% CI, 0.2%-70.5%). In the patient cohort who rejected AT, a worse OS was associated with female sex (48.6% vs 90.5%; difference, 41.9%; 95% CI, 0.6%-84.4%), pT1-2 category (57.1% vs 92.3%; difference, 35.2%; 95% CI, 3.3%-73.6%), and pN1 or higher category (61.2% vs 82.6%; difference, 21.4%; 95% CI, 14.1%-56.8%). Lower RFS was associated with female sex (37.9% vs 90.9%; difference, 53.0%; 95% CI, 8.0%-97.9%), advanced T category (pT3-4, 35.3% vs 80.0%; difference, 44.7%; 95% CI, 6.4%-95.3%), lymph node yield of 20 or greater (31.4% vs 80.6%; difference, 49.2%; 95% CI, 4.9%-93.4%), and lymph node ratio of less than 4.6% (36.6% vs 84.4%; difference, 47.8%; 95% CI, 1.8%-93.1%).Conclusions and RelevanceIn this cohort study of patients with advanced OSCC, refusal of AT was associated with worse oncological outcomes. The prevalence of disease recurrence during follow-up was 34% higher in patients who refused AT than in patients who completed AT. The results from this study may assist clinicians in guiding patients who are considering refusal of or withdrawal from AT.

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“…Since outcome of patients with locally advanced SCCHN require improvement, many preclinical and clinical studies have been conducted during recent years (17)(18)(19)(20)(21)(22). The prognoses of patients with SCCHN are particularly poor, if unresectable or incompletely resected.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Conventional Fractionation and Accelerated Fractionation With Concomitant Boost for Radiotherapy of Non-metastatic Stage IV Head-and-Neck Cancer

Narvaez

Schild

Rades

2021

In Vivo

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Clinical Outcomes of Head and Neck Cancer Patients Who Undergo Resection, But Forgo Adjuvant Therapy

Cited by 12 publications

References 15 publications

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

Comparison of Conventional Fractionation and Accelerated Fractionation With Concomitant Boost for Radiotherapy of Non-metastatic Stage IV Head-and-Neck Cancer

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