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Clinical Trial
. 2024 Jun 3;30(11):2393-2401.
doi: 10.1158/1078-0432.CCR-23-3247.

Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC

Paul L Swiecicki  1 , Emily Bellile  2 , Aleksandar F Dragovic  3 , Jonathan McHugh  4 , Aaron Udager  4 , Michelle Lynn Mierzwa  3 , Jennifer Shah  3 , Molly Heft-Neal  5 , Andrew Rosko  5 , Kelly M Malloy  5 , Keith Casper  5 , Steven Bennett Chinn  5 , Andrew G Shuman  5 , Chaz Stucken  5 , Douglas B Chepeha  5 , Gregory T Wolf  5 , Carol Rossier Bradford  6 , Avraham Eisbruch  3 , Mark E Prince  5 , Francis P Worden #  1 , Matthew E Spector #  7
Affiliations
Clinical Trial

Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC

Paul L Swiecicki et al. Clin Cancer Res. .

Abstract

Purpose: Locoregionally advanced HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has excellent cure rates, although current treatment regimens are accompanied by acute and long-term toxicities. We designed a phase II deescalation trial for patients with HPV+ OPSCC to evaluate the feasibility of an upfront neck dissection to individualize definitive treatment selection to improve the quality of life without compromising survival.

Patients and methods: Patients with T1-3, N0-2 HPV+ OPSCC underwent an upfront neck dissection with primary tumor biopsy. Arm A included patients with a single lymph node less than six centimeters, with no extracapsular spread (ECS) and no primary site adverse features underwent transoral surgery. Arm B included patients who had two or more positive lymph nodes with no ECS, or those with primary site adverse features were treated with radiation alone. Arm C included patients who had ECS in any lymph node and were treated with chemoradiation. The primary endpoint was quality of life at 1 year compared with a matched historical control.

Results: Thirty-four patients were enrolled and underwent selective neck dissection. On the basis of pathologic characteristics, 14 patients were assigned to arm A, 10 patients to arm B, and 9 to arm C. A significant improvement was observed in Head and Neck Quality of Life (HNQOL) compared with historical controls (-2.6 vs. -11.9, P = 0.034). With a median follow-up of 37 months, the 3-year overall survival was 100% and estimated 3-year estimated progression-free survival was 96% [95% confidence interval (CI), 76%-99%].

Conclusions: A neck dissection-driven treatment paradigm warrants further research as a deintensification strategy.

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Conflict of interest statement

Conflicts of Interest: The authors declare no potential conflicts of interest

Figures

Figure 1:
Figure 1:
CONSORT Diagram
Figure 2:
Figure 2:
Longitudinal Head and Neck Quality of Life Outcomes Stratified by Functional Domain. Pre-treatment (Pre Trt), Pre-radiation (Pre).
Figure 3:
Figure 3:
Kaplan Meier estimates of Overall Survival and Progression Free Survival
See this image and copyright information in PMC

References

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