Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

Abstract

Background Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. Methods The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. Results A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56–1.28), ENE (HR 0.93, 95% CI 0.69–1.27) or both (HR 0.73, 95% CI 0.41–1.31). Conclusions In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.

Current status and future perspective of postoperative treatment for locally advanced squamous cell carcinoma of the head and neck

“…Results were promising: the primary endpoint of 2-year progression-free survival was 96.9% (90%CI, 91.9–100) in Arm A, 94.9% (90%CI, 91.3–98.6) in Arm B, 96.0% (90%CI, 92.8–99.3) in Arm C and 90.7% (90%CI, 86.2–95.4) in Arm D. These results are particularly impressive for patients with intermediate risk who were treated with reduced dose PORT and provide sound justification for a Phase III trial. In part confirmation of treatment deintensification for HPV-positive oropharyngeal cancer, a large-scale retrospective analysis of over 14 000 patients from the National Cancer Data Base reported that the addition of chemotherapy to PORT was not associated with an improvement in treatment outcomes for p16-positive oropharyngeal cancer patients with high-risk factors for recurrence ( 41 ). Nevertheless, any implementation of deintensification strategies in clinical practice should be approached with caution, since many randomized trials of deintensification for HPV-positive oropharyngeal cancer patients failed to show the non-inferiority of deintensification to the standard treatment strategy ( 42–44 ).…”