IS BIGGER BETTER?: ESCALATION to TRIMODALITY THERAPY and OVERALL SURVIVAL in T1-2,N2b,M0 HPV-NEGATIVE OROPHARYNGEAL SCC

Monday, October 13, 2025

1:48 PM - 1:54 PM EDT

Location: 127

Disclosure(s):

Claire S. Malhotra, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Aru Panwar, MD FACS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Whether patients with HPV negative oropharyngeal SCC (HPVnegOPSCC) eligible for definitive chemoradiotherapy (CXRT) experience improved overall survival (OS) with ‘escalation’ to tri-modality therapy (Surgery + adjuvant CXRT [Surgery+CXRT]) is unclear. We compared OS for patients with cT1-2, N2b, M0 (Stage IVa) HPVnegOPSCC who undergo CXRT, Surgery+XRT or Surgery+CXRT.

Methods: Retrospective analysis of NCDB (2004-2021) for patients with T1-2, N2b, M0 HPVnegOPSCC who underwent curative intent bi- or tri-modality therapy. Baseline characteristics, comorbidities, staging data, extent of surgery, radiotherapy dose, and receipt of chemotherapy were evaluated. Kaplan-Meier survival analyses with log-rank test and Cox proportional hazards models were used to compare inter-group OS.

Results: Of 504 patients, 418 (83%) underwent CXRT, 31 (6%) Surgery+XRT, and 55 (11%) Surgery+CXRT. Median (IQR) radiotherapy dose was 7000 cGy (6996-7000) in CXRT group, 6000 cGy (6000-6600) in Surgery+XRT group, and 6996 cGy (6300-7000) in Surgery+CXRT group. There were 134 deaths including 111 (27%) in CXRT (follow-up, mean [SD], 28 [14] months), 6 (19%) in Surgery+XRT (follow-up, 32 [16] months), and 17 (31%) in Surgery+CXRT groups (follow-up, 29 [14] months).

Cox proportional hazards models identified no differences in OS between CXRT Vs. Surgery+CXRT (HR 0.56, 95%CI 0.08-4.11) and CXRT Vs. Surgery+XRT (HR 0.43, 95%CI 0.05-3.51). Comparison of CXRT Vs. a combined group undergoing surgery with adjuvant therapy indicated no difference in OS (HR 0.52, 95%CI 0.07-3.72). Kaplan-Meier survival analyses did not demonstrate any significant differences in OS between groups on log-rank test for either set of analyses.

Conclusions: For survivors with cT1-2 N2b M0 HPVnegOPSCC, there was no difference in OS between patients treated with CXRT or those receiving surgery+CXRT. These findings may inform shared decision making when considering oncologic benefits Vs. treatment-related adverse effects, and when designing clinical trials for patients with HPVnegOPSCC.

Presenting Author(s)

Claire S. Malhotra, BS

M4
Creighton University School of Medicine
Omaha, Nebraska, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Nicole K. Rud, BA

Medical Student
Creighton University School of Medicine
Omaha, NE, United States

Disclosure information not submitted.
Harlan R. Sayles, PhD

Assistant Professor
College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Omaha, NE, United States

Disclosure information not submitted.
Oleg Militsakh, MD

Professor of Surgery
Estabrook Cancer Center - Nebraska Methodist Hospital
Omaha, NE, United States

Disclosure information not submitted.
Andrew J. Holcomb, MD

Head and neck surgeon
Nebraska Methodist Hospital
Elkhorn, NE, United States

Disclosure information not submitted.
Andrew Coughlin, MD

Associate Professor
Nebraska Methodist Hospital Estabrook Cancer Center
OMAHA, Nebraska, United States

Disclosure information not submitted.
AO

Angela Osmolak, MD

Methodist Estabrook Cancer Center, Omaha, Nebraska, United States

Disclosure information not submitted.
RL

Robert Lindau, MD

Methodist Estabrook Cancer Center, Omaha, Nebraska, United States

Disclosure information not submitted.
Apar Kishor Ganti, MD

Professor of Internal Medicine
University of Nebraska Medical Center, Omaha, Nebraska
OMAHA, NE, United States

Disclosure information not submitted.
WL

William Lydiatt, MD

Methodist Estabrook Cancer Center, Omaha, Nebraska, United States

Disclosure information not submitted.

Senior Author(s)

Aru Panwar, MD FACS

Head and Neck Surgical Oncology
Methodist Estabrook Cancer Center
Omaha, Nebraska, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.