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• W2896729624 abstract "Level 1 evidence suggests an overall survival (OS) benefit with the addition of concurrent chemotherapy to adjuvant radiation in patients with head and neck squamous cell carcinoma (HNSCC) who have pathologic positive margins (+margin) or extra-nodal extension (ENE). It is uncertain whether this benefit persists in HPV positive oropharyngeal cancer patients with similar risk factors. We sought to analyze adjuvant patterns of care and their impact on OS in HPV positive oropharyngeal patients with high risk pathologic features. We used the National Cancer Database to select a population of surgically treated (>local excision), pathologically high risk (+margin or ENE) patients with non-metastatic, HPV positive, squamous cell carcinoma of the oropharynx who received either adjuvant radiation (aRT) or chemoradiation (aCRT). Univariable and multivariable logistic regression was used to assess predictors of the use of aCRT compared to aRT in this cohort. Univariable and multivariable Cox regression was then performed to evaluate the impact of adjuvant treatment type on OS. Age (<55, 55-64, ≥65), gender (male, female), race (White, Black, Other), Charlson-Deyo comorbidity score (0, 1, ≥2), AJCC 7th edition stage (I, II, III, IVA, IVB), facility type (non-academic, academic), high-risk feature (+margin, ENE, both), insurance (none, private, Medicaid, Medicare, other/unknown), and year of diagnosis (2010-2012, 2013-2014) were included as confounders. There were 1,638 patients who met inclusion criteria; 436 (26.6%) received aRT and 1,202 (73.4%) received aCRT. Median follow up was 42 months and median RT dose was 6600cGy. On multivariable logistic regression, stage IVA-IVB (OR 3.31-5.81, p=0.001), presence of ENE (OR 1.42, 95% CI 1.04-1.92, p=0.027) or both ENE and +margin (OR 1.69, 95% CI 1.12-2.56, p=0.013) were associated with increased likelihood of receiving aCRT. Treatment at an academic facility (OR 0.65, 95% CI 0.50-0.85, p=0.002) was associated with decreased likelihood of receiving aCRT. The 5-year survival was 87.3% with aRT and 89.9% with aCRT (p=0.469); on multivariable analysis, there were no OS difference comparing postoperative CRT to postoperative RT (HR 0.68, 95% CI 0.44-1.05, p=0.079). Although not significant, after adjustment for confounders, there was a trend towards improved OS with aCRT compared to aRT in surgically treated OPC patients with high risk features. De-escalation of adjuvant therapy in this group, especially those with multiple high risk features, should be undertaken with caution." @default.
• W2896729624 created "2018-10-26" @default.
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• W2896729624 date "2018-11-01" @default.
• W2896729624 modified "2023-10-16" @default.
• W2896729624 title "Impact of Postoperative Chemoradiation for HPV Positive Oropharyngeal Cancers with Extranodal Extension and/or Positive Margins" @default.
• W2896729624 doi "https://doi.org/10.1016/j.ijrobp.2018.07.937" @default.
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