Deescalated Adjuvant Therapy Important for HPV-Positive Head and Neck Cancer, Study Finds
The investigators aimed to determine the value of ECS as a prognosticator and adjuvant therapy determinant in surgically resected, HPV-related OPSCC. The investigators selected 152 patients who had p16-positive primary OPSCC and pathologically positive necks and measured ECS from routine reporting (ECSreport) and by using a novel histologic grading system (ECSgraded).
The investigators reported that the presence of ECS was not associated with poorer disease-free survival (ECSreport: hazard ratio [HR], 3.42; 95% confidence interval [CI], 0.45-25.88; P=.23; ECSgraded: HR, 2.54; 95% CI, 0.88-7.34; P=.09). T-stage and high-grade ECS, ie, soft tissue metastasis (STMgraded), were prognostic. Overall, and in the presence of ECS or even STM, adjuvant chemoradiotherapy (CRT) was not associated with better disease-free survival over radiotherapy alone (HR, 0.25; 95% CI, 0.06-1.13; P=.07). In addition, matched analyses demonstrated no significant reduction in disease-free survival for the presence of ECS vs the absence of ECS or reduced disease-free survival for the administration of adjuvant radiotherapy alone vs CRT in ECS-positive patients.
The investigators concluded: “Routinely reported ECS was not prognostic in this study; adjuvant CRT vs radiotherapy alone produced no improvement in DFS for ECS-positive patients.”