Abstract
e18505 Background: Adjuvant chemoradiation (ACRT) is indicated in the presence of margin positivity or extranodal extension. However, indications of ACRT post neoadjuvant chemotherapy (NACT) is not well defined. At our centre, ACRT is administered in the majority of patients who undergo NACT. This analysis was performed to identify indications for the avoidance of ACRT post NACT. Methods: 160 very locally advanced borderline resectable HNSCC who underwent surgery after NACT were selected. The adjuvant treatment administered was either radiation or chemoradiation at the discretion of the joint clinic. The post-surgical tumour and nodal specimen were graded in accordance with modified tumour regression grade (MTRG). Where grade 1 indicated a complete pathological response. The primary endpoint was disease-free survival (DFS). The patients were divided into 3 biological distinct classes. Group-1 had a pathological complete response (CR) in both tumour and nodes, Group-2 had pathological CR in either tumour or nodes and Group 3 had no pathological CR. Kaplan Meier method was used for the estimation of DFS. The stratified (for groups) log-rank test was used for evaluating the impact of adjuvant radiation. Stratified Cox regression analysis was used for the calculation of hazard ratio. A p-value of 0.05 was considered significant. Results: There were 56 patients (35%) in group 3, 75 (46.9%) in group 2 and 29 (18.1%) in group 1. The overall median DFS was 89.067 months (95%CI 15.345-162.788). The 5-year DFS was 22.1% in group 3, 75.4% in group 2 and 92.3% in group 1 ( P-value < 0.0001). Adjuvant radiation was received by all patients and concurrent chemotherapy was received by 134 (83.8%) patients. Use of concurrent chemotherapy decreased the hazard of disease recurrence (HR-0.297 95%CI 0.135-0.656, P-value = 0.003). The stratified log-rank test p-value was 0.002. Conclusions: Adjuvant chemoradiation is needed after neoadjuvant chemotherapy in very locally advanced borderline resectable head and neck cancer
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