(ChemotherapyAdvisor) – De-escalated adjuvant therapy should be considered for patients with human papillomavirus p16-positive oropharyngeal squamous cell carcinoma (OPSCC) who undergo surgery and routinely reported extracapsular spread (ECS) should not be used to justify adjuvant chemotherapy, according to team of researchers of Washington University School of Medicine, St. Louis, MO. This conclusion is based on a study entitled “Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma,” which is published in the July 15 of Cancer

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.

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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.”