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Video

Head and Neck Surgery

(A529) Current trends in de-escalation of post-operative radiation therapy in HPV-associated oropharyngeal cancer

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • JH

    Jeffrey Do Huynh, BS

    Medical Student
    Stanford University School of Medicine
    San Jose, California, United States

    • Co-Author(s)

  • MC

    Michelle M. Chen, MD, MHS

    Department of Otolaryngology - Head & Neck Surgery, Stanford University, United States

    • Senior Author(s)

  • MC

    Michelle M. Chen, MD, MHS

    Department of Otolaryngology - Head & Neck Surgery, Stanford University, United States

    • Co-Author(s)

  • Chris Holsinger, MD, FACS

    Professor
    Department of Otolaryngology - Head & Neck Surgery, Stanford University
    Stanford, California, United States

  • JL

    Jake J. Lee, MD, MSCI

    Department of Otolaryngology - Head & Neck Surgery, Stanford University, United States

  • AF

    Andrey Finegersh, MD, PhD

    Assistant Professor, Otolaryngology
    Department of Otolaryngology – Head and Neck Surgery, Stanford University
    Palo Alto, CA, United States

Disclosure(s):
Jeffrey Do Huynh, BS: No relevant relationships to disclose.
Chris Holsinger, MD, FACS: No relevant relationships to disclose.


Introduction: This study evaluates the de-escalation of postoperative radiation doses in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) patients based on risk stratification, geographic location, and treatment setting.

Methods: Retrospective cohort study utilizing the NCDB that included all surgical patients with HPV-associated OPSCC (2009-2020). Risk stratification included: low-risk features (LR) with pT1-T2N0-N1 and negative margins, intermediate-risk (IR) with close margins, 2-4 metastatic lymph nodes (LN), or lymphovascular invasion; and high-risk (HR) with positive margins or 5+ metastatic LN. We examined the association between radiation dosage with risk stratification, patient socioeconomic status, urbanicity, and treatment setting using an unadjusted and adjusted ordinal regression as well as a multivariable logistic regression.

Results: A total of 7588 patients were included: 7108 LRC, 143 IRC and 337 HRC. Unadjusted models indicated patients with LR (OR=8.81, 95%CI 6.34-12.40) and IR (OR=3.68, 95%CI 2.25-6.04) were more likely to be de-escalated than those with HR. After adjusting for clinical, demographic, and pathologic characteristics, academic centers were associated with de-escalation (OR=1.79, 95%CI 1.39-2.32). LR (OR=3.30, 95%CI 1.26-8.91) was associated with decreased radiation dose, but IR was not (OR=1.34, 95%CI 0.45-4.03). There was no association of insurance, urbanicity, age, gender, education, or income with de-escalated post-operative radiation dose.

Conclusions: De-escalation of adjuvant therapy for oropharyngeal cancer has occurred primarily in academic centers. Further work is needed to understand barriers and facilitators to de-escalation at non-academic centers as well as improve access to oropharyngeal cancer care at academic centers.