Stage I HPV‐positive oropharyngeal cancer: Should all patients receive similar treatments?

Background Patients with clinical stage I human papillomavirus (HPV)–positive oropharyngeal squamous cell cancer (OPSCC) according to the American Joint Committee on Cancer (AJCC) eighth edition classification comprise a heterogeneous group formerly classified as stage I to stage IVA according to th...

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Bibliographic Details
Published in:Cancer 2020-01, Vol.126 (1), p.58-66
Main Authors: Yoshida, Emi J., Luu, Michael, Mallen‐St. Clair, Jon, Mita, Alain C., Scher, Kevin S., Lu, Diana J., Nguyen, Anthony T., Shiao, Stephen L., Ho, Allen S., Zumsteg, Zachary S.
Format: Article
Language:English
Subjects:
Cancer
Cancer therapies
Chemotherapy
Classification
head and neck chemoradiation
Human papillomavirus
human papillomavirus (HPV)–positive
Lymph nodes
lymph node–positive cancer
Lymphatic system
Nodes
Oncology
Oropharyngeal cancer
Patients
Radiation therapy
stage I oropharyngeal cancer
Survival
Throat cancer
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Summary:Background Patients with clinical stage I human papillomavirus (HPV)–positive oropharyngeal squamous cell cancer (OPSCC) according to the American Joint Committee on Cancer (AJCC) eighth edition classification comprise a heterogeneous group formerly classified as stage I to stage IVA according to the seventh edition of the AJCC classification. These patients historically were treated with disparate treatment regimens, particularly with respect to the use of concurrent chemotherapy. Methods The National Cancer Data Base was queried for patients with AJCC eighth edition clinical stage I HPV‐positive OPSCC (AJCC seventh edition stage T1‐2N0‐2bM0) who were diagnosed from 2010 to 2014 and underwent definitive radiotherapy. Concurrent chemotherapy with definitive radiotherapy was defined as chemotherapy administered within 7 days of the initiation of radiotherapy. Results The current analysis included 4473 patients with HPV‐positive stage I OPSCC with a median follow‐up of 36.3 months. A total of 3127 patients (69.9%) received concurrent chemotherapy. Concurrent chemotherapy was found to be associated with improved overall survival on multivariable analyses (hazard ratio [HR], 0.782; 95% CI, 0.645‐0.948 [P = .012]). The effect of chemotherapy on survival varied based on lymph node involvement (P for interaction = .001). Specifically, chemotherapy was associated with improved survival for patients with lymph node–positive stage I disease (stage III‐IVA according to the AJCC seventh edition: HR, 0.682; 95% CI, 0.557‐0.835 [P 
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.32501