Variation in use of postoperative chemoradiation following surgery for T1 and T2 oropharyngeal squamous cell carcinoma; National Cancer Database

Abstract

Background and Objectives Primary surgical treatment of patients with early T-classification (T1-T2) oropharyngeal squamous cell carcinoma (OPSCC) has increased. We sought to determine how often these patients receive postoperative chemoradiation (CRT). Methods Patients with T1-T2 OPSCC in the National Cancer Database who underwent primary surgery were evaluated for receipt of postoperative CRT. Postoperative CRT use was examined among patients with high risk factors (positive margins and/or extracapsular spread (ECS)), intermediate risk factors (negative margins, no ECS, and either pT3–4 and/or N2-N3), and no apparent risk factors. Results Of 4,833 patients with T1-T2 OPSCC who underwent primary surgery, 43% had high risk pathologic factors, of whom only 63% received postoperative CRT. Another 31% had no apparent risk factors, of whom 16% nonetheless received postoperative CRT. On multivariable analysis, in addition to tumor and demographic factors, patients treated at community hospitals were more likely to receive postoperative CRT (O.R. 1.41 C.I. 1.18–1.87, p=0.001). Conclusions Variation in postoperative CRT use indicates a lack of consensus and/or knowledge about its benefits and indications. Usage of postoperative CRT regardless of pathologic risk factors suggests an area where future efforts at implementation of best practices may be targeted.

Disparities and guideline adherence for HPV testing among patients with oropharyngeal squamous cell carcinoma, NCDB, and SEER

“…Disparities in HPV testing may reflect differences in access to pathologists and pathology departments that perform the test. It has been shown that guideline changes are slowly adopted in the field of head and neck and thyroid cancer 17,18 . In addition, HPV testing can be expensive and the various methodologies are not yet standardized 17,19 .…”

Benefit from surgery with additional radiotherapy in N1 head and neck cancer at the time of IMRT: A population-based study on recent developments

“…In the case of positive resection margins, chemotherapy should be applied in accordance with recent guidelines. [9,10] In this study, all patients receiving chemotherapy were excluded (Fig 1). Thus, we do not expect a serious bias due to positive resection margins.…”

“…[8] Regarding the question of PORT in T1/2 HNC, the NCCN guidelines provide the following recommendation in relation to risk profile: Adjuvant irradiation should be used in patients with oropharynx and hypopharynx cancer and a pN0 or N1 situation as soon as multiple minor risk factors-e.g., perineural invasion, lymphovascular space invasion or close margins (< 5 mm)-appear. [9,10] If an extranodal extension (ECE) and/or positive resection margins occur, adjuvant chemoradiotherapy is recommended. [9][10][11] In patients with oral cavity cancer and a N1 situation, adjuvant irradiation should be considered.…”

“…[9,10] If an extranodal extension (ECE) and/or positive resection margins occur, adjuvant chemoradiotherapy is recommended. [9][10][11] In patients with oral cavity cancer and a N1 situation, adjuvant irradiation should be considered. [11] In recent years, the more advanced technique of intensity-modulated radiotherapy (IMRT) entered clinical practice.…”

Benefit of postoperative radiotherapy for early tumors with single ipsilateral lymph node metastasis

“…[4][5][6][7] Nevertheless, it is debatable for patients with locally circumscribed primaries (pT1-pT2) with a single ipsilateral lymph node metastasis (pN1) and without the previously mentioned adverse features. 6,8 One reason is that no results of prospective randomized trials addressing this topic are available. Only a few retrospective studies [9][10][11][12][13][14] provide data upon which therapeutic recommendations and rational clinical decision making can be based.…”