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Late-Breaking Scientific Oral Presentations

Head and Neck Surgery

Session: Late-Breaking Scientific Orals: Head and Neck Surgery

Matter of Survival: Adjuvant ChemoXRT Versus XRT Alone in Surgically-Treated HPV-Positive Oropharyngeal Squamous Cell Carcinoma With >4 Positive Nodes

Sunday, September 29, 2024
4:48 PM – 4:54 PM EDT
Location: MBCC, 222
Disclosure(s):
Sebastian J. Lane, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Madeline G. Deanne, BMA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Harlan R. Sayles, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: There is equipoise regarding the addition of chemotherapy during adjuvant radiotherapy following curative intent surgery for pT0-2, pN2, cM0 HPV+OPSCC, when the only high risk feature is the presence of >4 positive nodes. This is a comparative analysis of overall survival (OS) amongst patients who underwent curative intent surgery for pT0-2, pN2, cM0 HPV+OPSCC, and received adjuvant radiotherapy with or without chemotherapy.

Methods: This is a retrospective analysis of NCDB data (2004-2021) for patients with pT0-2, pN2, cM0 HPV+OPSCC who underwent surgery with adjuvant therapy, and had >4 positive regional nodes, without positive margin or extranodal extension (ENE). Baseline characteristics, staging data, extent of surgery, radiotherapy dose, and receipt of chemotherapy were evaluated. Kaplan-Meier survival analyses with log rank test and a Cox proportional hazards model were used to compare OS between patients who received adjuvant chemoradiotherapy (ChemoXRT) versus radiotherapy alone (XRT).

Results: Of the 131 patients (115 [88%] male, mean age 58.7 years [SD 9.9]) who met criteria and with complete follow up information, 63 (48%) received adjuvant chemoXRT. Median radiotherapy dose was 6000 cGy in both chemoXRT (IQR 6000-6600) and XRT (IQR 6000-6000) groups.

In total, 4 patients (6.4%) died in chemoXRT group during follow up (mean 31.9 months), and 7 (10.3%) in the XRT group (mean follow up 35.2 months). A Cox proportional hazards model identified no difference in OS between patients in chemoXRT and XRT groups (adjusted HR 0.709, 95%CI 0.207-2.431, p = 0.58). Kaplan-Meier survival analysis did not demonstrate any significant differences in OS between groups on log-rank test (p = 0.59).

Conclusions: In this NCDB analysis, amongst patients with pT0-2, pN2, cM0 HPV+OPSCC who underwent surgery with adjuvant therapy, and had >4 positive regional nodes, without positive margin or ENE, there was no OS benefit to ChemoXRT compared to XRT. These findings may encourage additional prospective evaluation regarding use of chemotherapy in the adjuvant setting for patients with no other risk factors except >4 positive nodes.

    Presenting Author(s)

  • Sebastian J. Lane, MD

    Surgery Resident
    Methodist Estabrook Cancer Center & Creighton University School of Medicine
    Omaha, NE, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Madeline G. Deanne, BMA

    MD-MPH Candidate
    Creighton University School of Medicine
    Council Bluffs, IA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Herschel B. Patel, MD

    Fellow
    Methodist Estabrook Cancer Center & Creighton University School of Medicine
    Dallas, TX, United States

    Disclosure information not submitted.

  • Harlan R. Sayles, MS

    Statistician III
    College of Public Health, University of Nebraska Medical Center
    Omaha, NE, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Aru Panwar, MD

    Associate Professor, Head & Neck Surgical Oncology
    Methodist Estabrook Cancer Center & Creighton University School of Medicine
    Omaha, Nebraska, United States

    Disclosure information not submitted.