ADJUVANT RT FOR T2N1 ORAL AND OROPHARYNGEAL CANCER

NEW YORK (Reuters Health) - Adjuvant postoperative radiotherapy (PORT) boosts survival particularly in younger patients with T2N1 oral cavity (OC) and oropharyngeal (OP) squamous cell carcinoma (SCC), new research shows.

"The results of this study suggest that postoperative radiation therapy should be strongly considered in T2N1 patients even in patients without adverse features," Dr. Vasu Divi told Reuters Health by email.

As reported November 10 online in JAMA Otolaryngology-Head and Neck Surgery, Dr. Divi of Stanford University Medical Center in Palo Alto, California and colleagues reviewed information from the National SCC Database for 2004 to 2013.

Among the exclusion criteria were receipt of neoadjuvant radiotherapy, any chemotherapy, or any treatment with palliative intent.

PORT was employed in 740 of 1467 patients with OC SCC (50.4%) and 449 of 790 with OP SCC (56.8%).

After controlling for factors including pathologic characteristics, in patients with pN1 disease without adverse features, PORT was associated with improved overall survival in both OC patients (hazard ratio, 0.76) and OP patients (OR, 0.62)

This association persisted in patients younger than 70 years, for both OC (HR, 0.77) and OP (0.48). Corresponding values for those with pT2 disease were 0.64 and 0.56.

This was not the case for patients 70 years or older (HR, 0.78) or those with pT1 disease (HR, 0.80). And, say the investigators, "Limited data are available on the tolerance and benefit of PORT in elderly patients."

The researchers point out that for patients with OC SCC, National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of PORT. For patients with OP SCC, PORT is no longer recommended.

The current findings, they add, "suggest that we should continue to study the effect of this change in the NCCN guidelines." And, added Dr. Divi, "When updating the guidelines, clinicians should differentiate between T1N1 and T2N1 disease."

Commenting by email, Dr. Frank Worden told Reuters Health that while retrospective data must be interpreted cautiously, "they did evaluate a fair number of patients. I think what is most telling is the possible support for radiation therapy in OC and OP patients with small primary tumors and one lymph node."

Dr. Worden, of the University of Michigan Comprehensive Cancer Center in Ann Arbor, added, "Typically, in such patients, we may consider close observation in lieu of no adverse features, so improvements in survival may alter our thinking especially in younger patients."

He concluded, "It is important to note that the benefits of chemo RT in patients greater than 65 is also limited, so the fact that they looked at this population and found similar findings suggest support for not administering adjuvant therapy in this patient population."

SOURCE: http://bit.ly/2fFTfAi

JAMA Otolaryngol Head Neck Surg 2016.