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Concurrent immunoradiation for HPV-associated oropharyngeal squamous cell carcinoma

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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

Current trials for HPV-associated oropharyngeal SCCs (OP-SCCs) are evaluating treatment de-escalation including use of concurrent immunotherapy with radiation therapy (I-RT). Given limited prospective data following I-RT, we aimed to examine this question utilizing the National Cancer Data Base (NCDB).

Methods

The NCDB was queried for patients with HPV-associated OP-SCCs eligible for current de-escalation studies with AJCC 7th edition T1–T2/N1–N2b and T3/N0–N2b disease. Patients were stratified into I-RT, concurrent chemoradiation (C-RT), and radiation therapy alone (RT) arms. Kaplan–Meier analysis was utilized to compare overall survival (OS) between treatment arms followed by a Cox multivariate (MVA) proportional hazards model controlling for tumor and patient characteristics and propensity-score analyses with inverse probability treatment weighting (IPTW).

Results

We identified 4768 patients; 313 received I-RT, 3660 patients received C-RT, and 795 received RT. Median age was 62 years (range 27–90) with a median Charlson–Deyo co-morbidity score of 0 (range: 0–3). The vast majority were cN1–N2a (88.8%) and 26.5% were cT3. On MVA, inferior 3-year and 8-year OS was noted following I-RT (81.6% and 70.5%) vs. C-RT (90.6% and 79.4%) (HR = 1.69 (95% CI: 1.29–2.21); p < 0.0001) with no significant difference vs. RT (88.1% and 75.8%) (HR = 1.07; p = 0.80). This was also maintained on IPTW-analysis (HR = 1.62 (95% CI: 1.23–2.15); p = 0.001).

Conclusions

I-RT was associated with significantly poorer OS vs. C-RT with no benefit compared to RT for HPV-associated OP-SCCs. I-RT is not recommended outside of currently accruing clinical trials.

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Authors and Affiliations

  1. Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA, 23219, USA

    Raj Singh & Shiyu Song

  2. Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA, USA

    John Austin Vargo

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Contributions

R.S. and S.S. initiated the project. R.S. was involved in data acquisition, organization, and management. R.S. and J.A.V were involved in data analysis and interpretation. R.S., J.A.V., and S.S. were involved in manuscript writing, editing, and preparation.

Corresponding author

Correspondence to Raj Singh.

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Conflict of interest

All authors declare no relevant conflicts of interest or disclosures related to the current submitted work.

Ethics approval

The procedures followed for the purposes of this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) or with the Helsinki Declaration (1964, amended in 1975, 1983, 1989, 1996 and 2000) of the World Medical Association.

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Not applicable, retrospective database study.

Research involving human participants and/or animals

Not applicable, retrospective database study.

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Singh, R., Vargo, J.A. & Song, S. Concurrent immunoradiation for HPV-associated oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 280, 797–809 (2023). https://doi.org/10.1007/s00405-022-07613-2

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  • DOI: https://doi.org/10.1007/s00405-022-07613-2

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