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TOPLINE:

Chemoradiotherapy did not extend overall survival compared with radiotherapy alone in patients with T1-2 low-volume nodal oropharyngeal squamous cell carcinoma (OPSCC), but locoregional control did improve in younger patients with multinodal disease. Overall, the findings suggest many patients can safely avoid chemotherapy-related toxicity.

METHODOLOGY:

• The incidence of OPSCC has risen with the increasing prevalence of human papillomavirus (HPV)-associated tumors. The potential benefit of adding concurrent chemotherapy to radiotherapy for patients with T1-2 N1-2b disease (single node > 3 cm or multiple ipsilateral nodes ≤ 6 cm) remains uncertain because data from randomized trials are lacking.
• Researchers used data from a Swedish head and neck cancer register to identify 1507 patients with T1-2 N1-2b OPSCC who received either radiotherapy or chemoradiotherapy between 2009 and 2022. HPV status was assumed based on p16 immunohistochemical expression. The standard radiotherapy dose was 68 Gy in 34 fractions, and concurrent chemotherapy was delivered as weekly cisplatin (40 mg/m²) when indicated.
• Patients were divided into two cohorts: those with single-node disease (cohort N1-2a) and those with multiple-node disease (cohort N2b). Propensity score matching was applied to balance baseline characteristics between radiotherapy and chemoradiotherapy treatment groups, resulting in 262 patients in cohort N1-2a and 692 patients in cohort N2b.
• Study outcomes were overall survival and locoregional control. The median follow-up duration was 5.5 years for overall survival and 4.1 years for tumor control in the unmatched cohort N1-2a and 5.7 years for overall survival and 4.3 years for tumor control in the unmatched cohort N2b.

TAKEAWAY:

• In patients with single-node disease, chemoradiotherapy offered no overall survival advantage over radiotherapy alone (hazard ratio [HR], 1.57; P = .17). The estimated overall survival at 5 years was 88% in both treatment groups. In patients with multinodal disease, overall survival was also similar between the groups (86% vs 83%; HR, 0.95; P = .77).
• At 5 years, locoregional control was not significantly different between patients with single-node disease who received chemoradiotherapy and those who received radiotherapy alone (94% vs 95%).
• However, chemoradiotherapy significantly improved locoregional control in patients with multinodal disease compared with radiotherapy alone (93% vs 84%) — a difference largely due to primary site failures, with over 80% occurring in patients with T2 tumors. In this group, age appeared to matter. Chemoradiotherapy improved locoregional control in patients with multiple nodes who were aged 70 years or younger (HR, 0.30; P < .001) but not in those older than 70 years (HR, 1.48; P = .48).

 IN PRACTICE:

“The lack of a benefit of [chemoradiotherapy] for patients with T1-2 N1-2a OPSCC in the current study suggests that these patients could be spared these potential [chemotherapy-related] side-effects and still achieve excellent outcomes,” the authors wrote. The authors added that for younger patients with multiple nodes, treatment discussions that weigh the potential for better tumor control with chemoradiotherapy against the risk for greater toxicity are “essential” — especially given the lack of survival advantage.

SOURCE:

This study, led by Gabriel Adrian, MD, PhD, Skane University Hospital in Lund, Sweden, was published online in the International Journal of Radiation Oncology, Biology, Physics.

LIMITATIONS:

The presence of extra-nodal extension, which has been shown to affect prognosis in HPV-associated OPSCC, was not available for analysis. Nodal burdens within each N-category and tumor volumes within each T-category could not be assessed. Additionally, data on the cumulative chemotherapy dose was not available. The findings cannot be extrapolated to 3-weekly high-dose cisplatin regimens.

DISCLOSURES:

Adrian reported receiving funding from the Swedish Society for Medical Research (Grant 23-0341), Mrs Berta Kamprad Foundation, and the Tegger Foundation. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.