Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins

Background Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with t...

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Published in:Head & neck 2022-03, Vol.44 (3), p.606-614
Main Authors: Fenlon, Jordan B., Hutten, Ryan J., Weil, Christopher R., Lloyd, Shane, Cannon, Donald M., Kerrigan, Kathleen, Cannon, Richard B., Hitchcock, Ying J.
Format: Article
Language:English
Subjects:
adjuvant extranodal extension
Carcinoma, Squamous Cell - pathology
Chemoradiotherapy
Chemoradiotherapy, Adjuvant
Chemotherapy
Clinical trials
Extranodal Extension
Humans
Margins of Excision
Neoplasm Staging
oropharyngeal neoplasms
Oropharyngeal Neoplasms - pathology
papillomavirus infections
Papillomavirus Infections - complications
Radiation
Retrospective Studies
Throat cancer
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Summary:Background Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. Methods The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. Results A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56–1.28), ENE (HR 0.93, 95% CI 0.69–1.27) or both (HR 0.73, 95% CI 0.41–1.31). Conclusions In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.26951