Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study

Eur J Surg Oncol. 2021 Jun;47(6):1389-1397. doi: 10.1016/j.ejso.2020.12.011. Epub 2021 Jan 1.

Abstract

Background: The aim of this study was to assess the impact of the initial therapeutic strategy on oncologic outcomes in patients with HPV-positive OPSCC.

Methods: All p16-positive OPSCCs treated from 2009 to 2014 in 7 centers were retrospectively included and classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Univariate, multivariate propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS).

Results: 382 patients were included (surgical group: 144; non-surgical group: 238). Five-year OS, DSS and RFS were 89.2, 96.8 and 83.9% in the surgical group and 84.2, 87.1 and 70.4% in the non-surgical group, respectively. These differences were statistically significant for DSS and RFS after multivariate analysis, but only for RFS after propensity score matching analysis.

Conclusion: In p16+ OPSCC patients, upfront surgery results in higher RFS than definitive radiotherapy ± chemotherapy but does not impact OS.

Keywords: Cancer; Human papilloma virus; Oropharynx; Radiotherapy; Surgery; Survival.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Antineoplastic Agents, Immunological / therapeutic use
  • Cetuximab / therapeutic use
  • Chemoradiotherapy, Adjuvant
  • Cisplatin / therapeutic use
  • Cyclin-Dependent Kinase Inhibitor p16 / metabolism*
  • Female
  • Humans
  • Induction Chemotherapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / surgery*
  • Neoplasm Staging
  • Oropharyngeal Neoplasms / metabolism
  • Oropharyngeal Neoplasms / pathology*
  • Oropharyngeal Neoplasms / therapy*
  • Oropharyngeal Neoplasms / virology
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / metabolism
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Survival Rate

Substances

  • Antineoplastic Agents, Immunological
  • CDKN2A protein, human
  • Cyclin-Dependent Kinase Inhibitor p16
  • Cetuximab
  • Cisplatin