Treatment deintensification to surgery only for stage I human papillomavirus-associated oropharyngeal cancer.

Abstract

6003Background: Human papillomavirus-associated (HPV+) oropharyngeal cancer (OPC) is an emerging entity with improved prognosis and distinct staging system. We assessed if deintensificaiton to surgery only decreased survival for stage I patients at low or intermittent risk compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). Methods: From the National Cancer Data Base (2010-2014), we identified patients with stage I HPV+ OPC (after restaging with eighth edition guidelines) treated with surgery only or with adjuvant RT or CRT. We compared survival for low risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate risk patients (2-4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). We excluded high risk patients with positive margins or macroscopic ENE. Results: We identified 2,463 patients with median follow-up of 44.3 months. In the low risk group 4-year overall survival was 93.0% with surgery only versus 95.6% with ...