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

Abstract

Objective: 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. Methods: The National Cancer Database was queried for cases of surgically resected to negative margins HPV ​+ ​OPSCC from 2010 to 2015. Demographics, tumor factors, and treatment data were obtained. Survival rates, hazard ratios (HR), and odds ratios were obtained. Propensity score matching was conducted. Results: 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 ​= ​0.216). The use of adjuvant CRT declined over the study period (P < 0.001) while ENE status remained the same (P ​= ​0.229). Conclusion: 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. Level of evidence: 4.

Keywords

• Extranodal extension
• HPV+
• Oropharyngeal SCC
• RT vs CRT