Adjuvant radiation vs Chemoradiation in HPV+ oropharyngeal squamous cell carcinoma with extranodal extension

Abstract

A survival benefit from adjuvant chemoradiotherapy (CRT) over radiotherapy (RT) in treatment of surgically resected Human Papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) with extranodal extension (ENE) remains unclear. The National Cancer Database was queried for cases of surgically resected to negative margins HPV + OPSCC from 2010-2015. Demographics, tumor factors, and treatment data were obtained. Survival rates, hazard ratios (HR), and odds ratios were obtained. Propensity score matching was conducted. 4971 patients met inclusion criteria. 60.7% received adjuvant CRT; 41.1% of cases were ENE+. ENE (HR: 2.28) increased risk of death. In ENE + cases, there was no difference in survival between CRT and RT cohorts following propensity score matching ( P = 0.231). The use of adjuvant CRT declined over the study period ( P < .001) while ENE status remained the same ( P = 0.229). The presence of ENE is a negative prognostic feature in HPV + OPSCC. However, the use of CRT over RT did not impart a survival benefit in patients with ENE + HPV + OPSCC surgically resected to negative margins. 4. • 1 – ENE was strongly predictive of receiving adjuvant CRT over RT alone. • 2 – Patients who had ENE had modestly worse survival compared to patients without ENE. • 3 – In patients with ENE, adjuvant CRT did not confer a survival benefit over adjuvant RT alone.